Lesson 7: (ESOL) Talking About Symptoms to Your Doctor
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Lesson 7: (ESOL) Talking About Symptoms to Your Doctor ∗
Disease Prevention and Screening
Task Addressed in this Lesson
• Describe symptoms clearly and
accurately to a doctor
Skills Focus
• Students will learn language
expressions and adjectives for
talking about symptoms.
• Students will develop
communication strategies that
can help them be as specific as
possible about the nature of
symptoms and the conditions
under which symptoms appear.
ABE/ESOL Level
Intermediate to advanced ESOL
Purpose
This lesson is designed to help students learn
how to describe their symptoms clearly and
effectively. This lesson begins by inviting the
students to discuss how talking to a doctor
about a health concern is a lot like talking to a
car mechanic about a problem with their car.
This analogy provides a framework for helping
students understand the value of being clear and
specific.
Students practice using details about symptoms,
including their character, duration, onset, and
conditions. A chart of vocabulary words used to
describe symptoms is provided.
Steps
1. Whole class discussion. Distribute the
handouts. Ask students to look at the page
titled Talking about Symptoms to Your
Doctor. Discuss the question How is talking
to a car mechanic when you have a problem
with your car a lot like talking to a doctor
when you have a health problem?
Time
2 hours
Materials
Student Handouts
Key Vocabulary
ache
constant
crusty
dull
exhaustion
frequent
itchy
inflammation
irritation
low energy
mild
moderate
occasional
oozing
severe
sharp
soreness
spotty
throbbing
tiredness
twinge
Give students a few minutes to write down
their thoughts. Then ask students to share
what they’ve written with the whole class.
(See possible responses below.)
∗
Material in this lesson is adapted from lessons in English Vocabulary in Use (Michael
McCarthy and Felicity O’Dell, 1994, Cambridge University Press) and information published by
the American Automobile Association (AAA) Web site, Communicating with Service
Professionals at http://www.csaa.com/home.
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It’s hard to know what’s wrong with a car and what’s wrong with our bodies
sometimes. We have to explain a lot of things to a car mechanic and a doctor
to figure out what is wrong.
Sometimes the car mechanic doesn’t understand what the problem is with the
car. Sometimes the doctor also doesn’t understand what the problem is with
our body.
Car mechanics and doctors both ask lots of questions.
It can be hard to find words to describe noises and feelings or sensations.
After students have had an opportunity share some of their ideas, explain that the
topic of the day’s lesson is how to talk to your doctor about your symptoms. Write the
word SYMPTOM on the board and ask students to help you define the word.
Encourage them to use their dictionaries and to translate the word into their first
language.
Here is a suggested definition:
It’s useful to think of symptoms as what the patient feels and signs as what the
doctor observes. Symptoms, like tiredness (fatigue) and pain, are subjective
experiences. (In contrast, signs, like abnormal pulse rate or high blood pressure,
are objective features of an illness that can be detected by the doctor during a
physical examination.) The doctor cannot easily measure or observe symptoms.
Only the patient knows exactly what his or her symptoms feel like. Doctors try to
understand the nature and pattern of a patient’s symptoms in order to make a
diagnosis.
2. Small group work: Reading and discussion. Organize the class into small groups of
three to four people. Ask the groups to read the handout titled Signs from Your Car,
Signs from Your Body. Explain that the reading talks more about the similarity
between talking to your car mechanic and talking to your doctor. After the group
reads the paragraph, they should answer the discussion questions from the handout.
Encourage the students to use their dictionaries or ask for help with unfamiliar
vocabulary. Record any new words and their meanings on the board for all to see.
Check in with each group to make sure they do not have trouble understanding the
ideas in the handout.
3. Large group discussion: What does it mean to be CLEAR and SPECIFIC?
Invite the groups to share their responses to the discussion questions. Be sure to check
the students’ understanding of what it means to be CLEAR and SPECIFIC when
describing your symptoms to a doctor. The more information you give to a doctor, the
more likely the doctor will be able to identify the problem.
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Be sure to recognize the students’ worries and concerns about talking to a doctor
about their symptoms. It is easy to be scared and nervous when talking to a doctor
about your health, especially when you don’t feel very well. At the same time, if you
are too scared or nervous, you may not be able to think clearly, describe your
symptoms effectively, or ask good questions.
Not all doctors are good listeners. Students will need help as they think about what to
say to a doctor. They need practice asking questions and planning skills to decide
what to focus on. Many people are assertive in this way when they talk to a car
mechanic because they want their car fixed quickly and in the right way. This is a
useful way of thinking about talking to doctors to avoid delays in getting health care.
4. Small group work: Practice describing symptoms. Ask students to turn to the
handout Practice: How to Describe Your Symptoms, which features several
questions that can help the students know what to say to the doctor about symptoms.
Ask the students to work in their small groups to read the questions and the examples
of things to say to a doctor. Ask the students to practice what they might say to a
doctor.
Also, refer students to the handout Vocabulary for Describing Symptoms, which
gives examples of words used to describe pain, tiredness, and rashes. Encourage the
students to use the words from this handout in their descriptions. Encourage students
to add other symptoms (e.g., fever, stress) and add other related nouns, verbs, and
adjectives to the list. The follow-up activities in this lesson describe ways to use this
handout for vocabulary development.
Follow-up Activities
A. Vocabulary for Describing Symptoms
Ask students to review the vocabulary in the handout Vocabulary for Describing
Symptoms, and to use a dictionary to learn the meanings of any new words. Students
can work in pairs to explore the differences in meaning for a group of words related
to a particular symptom. Students can discuss, for example, how a dull pain feels
different from a sharp pain, or how a twinge is different from a throbbing pain.
Encourage students to come up with strategies for remembering these differences,
such as ordering these words on a continuum to indicate severity of pain. For
example, students might generate mnemonics such as this:
0
no pain
mild
dull
5
moderate
throbbing
10
severe
Students can also work in pairs to generate descriptive words for other symptoms,
such as shortness of breath, fever, stress, or anxiety. Be sure to have a dictionary and
thesaurus on hand for each group.
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B. Interview someone about their experiences with being sick and managing
symptoms
Ask students to identify someone who has experience with being sick or managing a
chronic disease. The students will interview the person about the range of symptoms
the person had. This activity will help students understand the kinds of symptoms
associated with particular illnesses or diseases. Here is a suggested interview
protocol:
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Please tell me about the last time you were sick. (Please tell me about your
chronic disease.)
What were your symptoms?
When did you notice the symptoms? (When did the symptoms start?)
What were you doing when the symptoms started?
Did the symptoms happen all the time (constant) or only sometimes? When
did you have the symptoms (e.g., only at night)? How long did the symptoms
last (a few seconds, an hour, a week)? What seemed to make the symptoms
worse?
Did the symptoms make it hard for you to do everyday activities (e.g., eat,
sleep, and work)? How?
Did you do anything to feel better? (Did you take any medicine? Did you
rest?)
If you went to a doctor, were you able to explain your symptoms to the
doctor? How? Was the doctor able to help you feel better? How?
The students can summarize the person’s responses into an oral presentation or a
short descriptive essay. In a large group discussion, talk about common difficulties
people have in understanding symptoms and talking to doctors about symptoms.
ABE/GED Teaching Tips
Even those students who are native English speakers or who were born in Englishspeaking countries will likely find this lesson useful and relevant. Many people – whether
they speak English fluently or not – feel intimidated or unsure about what to say when
they visit a doctor.
At a conference (Health and Literacy Working Together) organized by the Iowa New
Readers, ∗ adult learners shared concerns about not being able to communicate well with
their doctors. These students wanted to tell their doctors, “Treat us with respect and we
will treat you with respect.” These students also wished their doctors would spend more
time with them. They want their doctors to give them clear instructions, for example,
∗
These comments were taken from conference proceedings but are not available on the Web. For more
information about the conference, visit
http://www.ihi.org/IHI/Topics/Improvement/ImprovementMethods/Literature/HealthandLiteracyWorkingT
ogether.htm
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when getting a new prescription. The students shared concerns about doctors who assume
their patients understand their instructions and can read the documents they are given.
The students were also concerned about the assumptions that doctors sometimes make
about patients who cannot read well. The students asked that doctors not "feel sorry for
us…we want (doctors) to try and understand us.”
You may wish to share some of these comments with your ABE/GED students as a way
to jumpstart the discussion of doctor-patient communication issues.
Technology Tips
Here are some suggested Web sites for learning more about patient-doctor
communication and symptoms.
9 Talking With Your Doctor: A Guide for Older People, National Institute on
Aging (NIA), part of the National Institutes of Health.
Features a section titled What Can I Do? Tips for Good Communication.
http://mdchoice.com/Pt/consumer/talk.asp
9 Improve communication with your doctor, Women’s Heart Foundation.
http://www.womensheartfoundation.org/content/HeartWellness/improve_doctor_
patient_communication.asp
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Lesson 7: (ESOL) Talking About Symptoms to Your Doctor
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Skills for Disease Prevention and Screening
Lesson 7: (ESOL) Talking about Symptoms to Your Doctor (HANDOUTS)
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Talking About Symptoms to Your Doctor
1. Warm-up. Brainstorm with your classmates.
How is talking to a car mechanic
when you have a problem with your
car a lot like talking to a doctor when
you have a health problem?
`
Write down your ideas. Share your ideas with your classmates.
2. Short reading and discussion
Read the handout titled Signs from Your Car, Signs from Your Body and answer
the discussion questions. Talk about your answers with your classmates.
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Skills for Disease Prevention and Screening
Lesson 7: (ESOL) Talking about Symptoms to Your Doctor (HANDOUTS)
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Signs from Your Car, Signs from Your Body
You know your car better than anyone else does
because you drive it every day. You know how it
acts when it's running right. You also know when
something is not quite right. When something is
not right with your car, it sends you a signal. In
the same way, you know what feels right with your
body.
When something is not right with your body, it sends you a signal, just
like a car does. The medical word for these signals is symptoms. A
symptom is the way your body lets you know that something is not
normal. A symptom may be a sharp pain or shortness of breath or a
lack of energy.
Talking to a mechanic about problems with your
car is a lot like talking to your doctor about
problems with your health. A mechanic will ask
you many questions to find out what is wrong
with the car. If you say, “My car doesn’t work,” the
mechanic will have to ask you many questions
to figure out the problem. But, if you say, “My car makes a loud noise
when I drive fast on the highway,” this helps the mechanic find the
problem faster. In the same way, your doctor can more easily figure
out a health problem if you are CLEAR and SPECIFIC. If you say, “I
feel sick,” the doctor will have to ask you many questions to find out
what is wrong. But, if you say, “I have a sharp pain in my arm when I
try to write,” you can help the doctor figure out the problem faster.
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Discussion Questions
1. Think of a time when you or someone you know (a member of
your family or a friend) was sick. What were the symptoms?
2. What can be difficult about talking to a doctor about your
symptoms?
3. Why do you think it’s important to clearly explain your
symptoms to a doctor?
4. What are ways that you can be CLEAR and SPECIFIC when you
talk to a doctor about your symptoms?
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Practice: How to Describe Your Symptoms
It is useful to think about what to say to the doctor before you go to
the doctor’s office. Here are some questions that you can ask yourself.
Your answers may help you be CLEAR and SPECIFIC when talking to
your doctor about your symptoms.
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What is the symptom? (Is it a pain? Is it a rash? Is it a feeling
of tiredness?)
When did you notice the symptom? (When did the symptom
start?)
What were you doing when the symptom started?
Does the symptom happen all the time (constant) or only
sometimes? When do you have the symptom (e.g., only at
night, when I’m moving)? What seems to make the symptom
worse?
How long does the symptom last (e.g., a few seconds, an
hour)?
How long have you had it (e.g., a week, a month)?
Does the symptom make it hard for you to do everyday
activities (e.g., eat, sleep, and work)? How?
Are you doing anything to try to feel better? (Do you take any
medicine? Do you rest?)
Here are some examples of how to describe symptoms:
“Doctor, I have a red rash on my stomach. I saw the rash
after dinner two nights ago. It hasn’t gone away.”
“Doctor, I have a sharp pain in my lower back. I was
lifting a heavy box at work a couple of weeks ago when I
first felt the pain. I took some aspirin and the pain went
away for a little while. The pain is getting worse.”
“Doctor, I have a mole on my left arm. The mole used to
be small, but I think it looks bigger and darker. I work
outside and I sometimes use sunscreen, but I often
forget.”
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“Doctor, I have chills and feel very weak, especially in the
late afternoon, before dinner.”
Don’t say, “Doctor, I don’t feel well. What’s wrong with me?”
Practice: Think of a time when you (or someone you know) didn’t
feel well or had a health problem. What were the symptoms? Imagine
that you were going to talk to a doctor about the problem. Answer as
many of the questions as you can that are listed in the handout titled
Practice: How to Describe Your Symptoms.
What do you want to tell the doctor? You can use the handout titled
Vocabulary for Describing Symptoms to find words for
describing symptoms, such as pain, fatigue, or a rash. Use a
dictionary or ask your classmates or your teacher for help with any
new words.
If you want to talk about a symptom that is not on the list, fill in a
blank row with the symptom and the other nouns, verbs, and
adjectives you would use to describe it.
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Vocabulary for Describing Symptoms
Symptom
Adjectives I
can use to
describe the
NATURE of the
symptom
Adjectives I can
use to describe
the DURATION of
the symptom
Nouns with
similar
meaning
Expressions
I can use to
describe the
symptom
pain
dull
mild
moderate
severe
throbbing
sharp
constant
occasional
frequent
soreness
ache
twinge
throbbing
I feel sore.
It aches.
It twinges.
It throbs.
fatigue
severe
mild
moderate
constant
occasional
frequent
tiredness
exhaustion
low energy
rash
spotty
red
itchy
oozing
crusty
mild
severe
occasional
frequent
reaction
inflammation
itchiness
irritation
I tire out.
I am
exhausted.
I have low
energy.
I have a skin
reaction.
My skin is
irritated.
My skin is
itchy.
It flares up.
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Skills for Disease Prevention and Screening
Lesson 8: (GED) Making Important Health Decisions
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Lesson 8: (GED) Making Important Health Decisions
Disease Prevention and
Screening Tasks Addressed in
the Lesson
ƒ Understand the purpose and
process of colorectal cancer
screening
ƒ Make health-related and
other types of important
decisions
ƒ Use a tool for making
important decisions
Skills Focus
ƒ Students will practice
science-related reading.
ƒ Students will review
vocabulary related to
colorectal cancer screening.
ƒ Students will practice
making a decision about
health screening.
ƒ Students will practice writing
about a big decision they
have faced.
Purpose
The purpose of this lesson is to provide students
with an opportunity to explore the process of
making important health-related decisions, in this
case about health screening.
The lesson is designed as two sessions. In the first
session, students learn about colorectal cancer and
the colonoscopy test and then explore decision
making through a role-play game. The second
session focuses on the Ottawa Personal Decision
Guide, a tool for making health and other important
decisions. Students have an opportunity to practice
using the guide and write about their own decisionmaking experiences.
Note to teachers: This lesson was designed around
the question of whether or not to have a
colonoscopy. You may wish to focus the lesson on
some other type of screening (e.g., amniocentesis,
HIV test) or health procedure that seems more
relevant to your students and still requires a
thoughtful decision process about participating in
the test or procedure.
ABE/ESOL Level
GED
Time (Two Sessions)
Session 1: 2 to 2½ hours
Session 2: 1½ hour
Materials
Watch or other timer
Handouts
Session 1
1. Introduction. Start the class with a discussion
prompt, such as the Decisions, Decisions!
diagram included in this lesson. Show the
prompt on an overhead transparency or copy it as
a handout.
Ask students the following question about the
prompt:
Key Vocabulary
benign
biopsy
cancerous
colon
colonoscopy
colorectal
complication
cons
option
polyp
pros
tumor
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What makes these decisions difficult?
e.g., They involve money; the consequences
might last a long time; the course of action
might be risky or might bring more problems
than person has already, etc.
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Lesson 8: (GED) Making Important Health Decisions
Page 2 of 26
Ask students the following questions:
Think about a time in your own life when you faced a big decision.
What made your decision difficult?
What influenced your decision?
What helped you make a decision?
Were you happy with your decision? Why?
Have students think for 1-2 minutes and then share stories in pairs for 5 minutes.
Have volunteers share some examples. Focus on influences and what helped with the
decisions. Keep a running list of influences on decision-making on the board or
overhead transparency.
2. Background Reading on Colorectal Cancer (Pairwork) Explain that in this lesson,
you will look at an example of a big decision that has to do with getting a health
screening test. Share the following scenario with students:
William just turned 52. At his last check-up, his doctor suggested that William
have a colonoscopy test. William is not sure whether or not to have the test. In
the next activity, we are going to try to help William make that decision.
Note that before students move on to discussing that decision, they will do a short
reading to help them understand what a colonoscopy test is all about.
Have students work in pairs to read the three handouts What is Colorectal Cancer?
Who is Likely to Get Colorectal Cancer? 1 and Colonoscopy. Students should then
answer the Colorectal Cancer Reading Comprehension Questions. Circulate
among pairs while they are working and bring the class back together to review
answers to the questions.
Remember, as an ABE teacher, you are not a medical expert, so technical questions
should be referred to a health professional!
1
These materials are adapted from the Healthy Roads Media Web site at
http://www.healthyroadsmedia.org/eng.htm.
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Colorectal Cancer Reading Comprehension Questions
(Teacher’s Answer Key)
I. Read the page titled, “What is Colorectal Cancer?” and answer the following
questions.
1. Digestive system
2. Tumor or polyp
3. Blood in or on stools; alternating between constipation and diarrhea; very thin or
narrow stools; feeling bloated or gassy; stomach pains; vomiting; losing weight
without trying; feeling tired all the time.
4. Eat fruits and vegetables every day; exercise
True or False
1.
2.
3.
4.
5.
False (stomach and small intestine)
True
False
False
True
II. Read the pages titled, “Who is Likely to Get Colorectal Cancer?” and
“Colonoscopy,” and answer the following questions.
1. More than 55,000
2. Being 50 or older; having (or having family members who have had) polyps or
colorectal cancer before; having chronic inflammation of the colon, such as
Crohn’s disease or ulcerative colitis
3. Take a daily vitamin with folic acid or folate; eat less red meat (2-3 serving per
week); eat deep-fried foods less often; eat less fatty foods; quit smoking; don’t
drink a lot of alcohol.
True or False
1.
2.
3.
4.
False
True
False
False
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3. The Big Decision Game (Large group activity) In this part of the lesson, students
take on roles to explore the process of making a decision such as whether or not to
have a colonoscopy.
Preparation
To begin, explain the three different roles available to students, and ask each student
to choose a role to play during this activity.
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Three people make up the team of decision-makers.
Explain that the job of this group is to make a decision about William’s
colonoscopy. As the “game” moves along, they will hear pieces of information
from the different kinds of influences that affect this kind of decision. Every time
the team hears new information, they will have 30 seconds to keep or change their
decision.
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Five people act as influences.
1 = personal views, beliefs, phobias, etc.
2 = family, friends, community
3 = money
4 = work
5 = health information/doctors
Explain that this group will serve as the voices of some of the influences that can
affect this kind of decision. Each person should write down the name of their
influence to hold up, so others know who they are (personal views, money, work,
etc). Each person will also be given examples of things that he or she can say
from this perspective. (See the Big Game Materials Influence Statements on
page 21 of this lesson.) You can also invite students to ad-lib, as long as what they
say represents their assigned influence.
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The rest of the class serves as observers and voters.
Explain that this group will listen to the influences and observe the decision
making of the decision-makers. This group should pay careful attention to the
reasons behind the team’s decisions at each step. They will be asked to vote on
the decision and share their observations and comments at the end of the game.
To Play the Game
1. First the decision team must make an initial decision (not final) based only on
hearing the question. The three people vote; the majority wins. The teacher or a
volunteer records the answer on the board or an overhead for all to see.
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2. Next, one of the influences reads a card with a statement on it. For example:
Personal Views says: “I hate doctors, needles and anything that has to do with a
hospital.”
3. The decision team then has 30 seconds to revise its decision or keep as is and
indicate why.
4. While the team is deliberating, the teacher polls the observers for a decision and
records their answer in a separate column on the board. Running records are made
of the decisions. (2 lists – 1- team and 1- observers). The teacher then compares
the decisions.
5. Next, another influence speaks. For example: Money says “My insurance only
covers part of the cost of the test. I’ll still have to pay $100.”
6. Again the team is asked to make a decision and indicate why, and the teacher
polls the observers and compares answers.
7. The same process continues until all influences have spoken at least twice. Then
influences and observers are offered the opportunity to add additional influences
or elements to the decision making process. “Would anyone like to add
something that our team should think about in making this decision?”
8. When no more influences or ideas are offered, the team must make its final
decision. It has no more than 2 minutes for this. During that time, the observers
are polled for their final decision. When time’s up, the team announces its
decision.
Sharing Observations and Comments
Once the team has offered its decision, ask observers the following questions:
What did you notice about how the team made its decision over time?
e.g., They never wavered, they changed a lot, etc.
What appeared to be the strongest influences on their decision?
e.g, They seemed very concerned with money, or how the decision
affected their family, etc.
Ask the whole class the following questions:
Let’s look at the observers’ decision making. What do you notice about their
decision-making route? Was it similar or different? How?
How might you draw the two decision-making paths?
Ask for volunteers to draw the decision making paths on the board or overhead.
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As a way to review the activities of the day, ask the students to generate the following
lists (bolded column headings). Record their answers in a table like the one below on
the board or an overhead.
Making Big Decisions
Influences on
decision
Personal views
Family, friends,
community
Money
Work
Health
information/
doctors
What makes
decision hard
e.g., Time pressures
Worries
Costs
Consequences
What helps with
decision
e.g., Information
Time and space to
think
Sources of
information
e.g., People
Doctors
Web
magazines
[Add others
generated from
student
discussions]
4. Homework Assignment: Use the Ottawa Personal Decision Guide 2 Distribute the
Ottawa Personal Decision Guide (found at the end of the lesson plan handouts) to
each student. Explain that this is one tool for people to use when they are facing a
difficult decision about health or other areas of life.
Point out that the guide is based on five key steps in the decision making process:
1) Clarify the decision.
2) Identify your role in decision-making.
3) Assess your decision-making needs.
4) Weigh the options.
5) Plan the next steps.
2
This guide was developed by the University of Ottawa, Ottawa Health Research Institute. It is available
on-line at http://decisionaid.ohri.ca/decguide.html.
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The guide allows a person to go through the decision-making process two times, since
sometimes new information becomes available, or our thoughts change over time – as
students probably observed during the big decision game.
Ask students to read over the Decision Guide for homework. As they read, ask
students to think about the following questions:
What would you find helpful about using this tool?
What would make it difficult to use?
How does this way of making a decision compare to your own way of making big
decisions?
HALL/NCSALL Health Literacy Study Circles+
Skills for Disease Prevention and Screening
Lesson 8: (GED) Making Important Health Decisions
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Session 2
1. Introduction Review the activities of the previous session, in which students learned
about the colonoscopy test and played the Big Decision Game. Ask students to
comment briefly on their impressions of the Ottawa Personal Decision Guide.
2. Practice Using the Decision Guide (Pairwork) Have students work in pairs for
about 25 minutes. Distribute one new copy of the decision guide to each pair.
(Students can keep the clean copy distributed for homework for their own future
reference.) Explain that in each pair, one student will play the role of the “decision
maker” around a current, imagined, or past decision. The other student will be the
“decision coach.” The coach will interview the decision maker, using the Decision
Guide. Together, the pair should complete one copy of the guide (as much as
possible).
When all pairs have finished, ask for volunteers to answer the questions:
What was most useful about this guide?
What was most difficult about using it?
How well does this guide match with how you make decisions?
Point out that you hope that the guide– or some parts of it – will be helpful to students
the next time they face a big decision.
3. Writing Activity (Individual practice) Ask students to think of a time when they
faced a big personal decision. Distribute the handout Essay: My Big Decision and
review the questions with all students. Have students begin to draft their essay.
Follow through to completion using your usual essay-writing procedures.
Note to teacher: This writing assignment may be done in class or as homework.
Follow-up Activities
A. Invite a guest speaker. Ask a health professional from the program’s community
to visit your class to talk about colorectal cancer and other types of screenings. Have
students prepare a list of questions in advance in preparation for this meeting.
B. Draw decision paths. Ask students to think about a big decision they once made
that are willing to share with the class. Have students make a drawing that represents
their path to the decision. For instance, was their path to a decision a straight line or
was it a winding road? Have students present their drawings to the class.
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Lesson 8: (GED) Making Important Health Decisions
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Technology Tips
1. Audio presentation of information
9 Healthy Roads Media
http://www.healthyroadsmedia.org/
The Healthy Roads website offers audio versions of much of its health
information. If you have access to a computer lab, you may want to have your
students go to the website and listen to the audio presentation on colorectal
cancer and other health topics.
2. More information on colonoscopy
9 WebMDHealth: Health Guide A-Z
http://my.webmd.com/hw/colorectal_cancer/hw209694.asp
This site offers more information on the colonoscopy test. It includes
diagrams of the large intestine, as well as a person having the procedure done,
and provides more detail on the actual procedure, including how to prepare,
how it feels, risks, and results.
9 National Digestive Diseases Information Clearinghouse: Colonoscopy
http://digestive.niddk.nih.gov/ddiseases/pubs/colonoscopy/
This site offers an explanation of a colonoscopy, including risks and
preparation. It also provides a diagram of the digestive system.
3. Medical test information form
9 WebMDHealth: Health Guide A-Z
http://my.webmd.com/hw/colorectal_cancer/hw209694.asp
The Medical Test Information Form can be accessed through a link within the
WebMD website on Colonoscopy, in the “How to Prepare” section. The
form can be used by patients use to gather information about medical tests. It
includes questions on the purpose of the test, what might happen if the test is
not done, risks associated with the test, how it will feel to have the test done,
and more.
HALL/NCSALL Health Literacy Study Circles+
Skills for Disease Prevention and Screening
Lesson 8: (GED) Making Important Health Decisions
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Skills for Disease Prevention and Screening
Lesson 8: (GED) Making Important Health Decisions (HANDOUTS)
Page 11 of 26
Decisions, Decisions!
Should I have that
operation the doctor
wants me to have?
Should I get
tested for that
disease I’ve
heard about?
Should we buy a
house instead of
renting?
Should we
move the family
to Florida?
HALL/NCSALL Health Literacy Study Circles+
Skills for Disease Prevention and Screening
Lesson 8: (GED) Making Important Health Decisions (HANDOUTS)
HALL/NCSALL Health Literacy Study Circles+
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Skills for Disease Prevention and Screening
Lesson 8: (GED) Making Important Health Decisions (HANDOUTS)
Page 13 of 26
What Is Colorectal Cancer? 3
Colorectal cancer is often called colon cancer. It is a common health
problem in the United States. It kills more people than any other type of cancer
except lung cancer. More than 55,000 Americans die from colorectal cancer each
year.
Colorectal cancer affects the large intestine, which is part of the body’s
digestive system. The digestive system breaks down food so your body can use it
for energy. After you eat a meal, your stomach starts to break down the
swallowed food. The broken-down bits of food go into the small intestine where
they’re broken down even further. The small intestine also absorbs nutrients into
your bloodstream from the broken- down food. The material that remains goes
into the first part of the large intestine (colon), where water is removed and it
becomes more solid. It then goes into the part of the large intestine called the
rectum, and passes out of your body as stool (also called bowel movements or
feces).
Colorectal cancer is a problem with cells in the large intestine. Cells are the
very small units that make up all living things, including the human body. They
are so small, you need a microscope to see them. There are billions of cells in each
person's body. Normally, cells grow and divide and know when to stop growing.
Sometimes, things go wrong and cells just continue to grow and divide out of
control. These uncontrolled cells can clump together to form a growth that sticks
out into the large intestine. This growth is known as a polyp, or a benign tumor.
A polyp itself is not cancerous at first, but it can eventually become cancerous.
Colorectal polyps are common in people over age 50. About 4 out of 10
people over age 50 have them. Some polyps become cancerous. When a polyp
becomes cancerous, it is also known as a malignant tumor. This means that cells
from the polyp can destroy the healthy tissue around the polyp and can invade
other body parts. This can be dangerous and difficult to treat.
Fortunately, most polyps are not cancer. A non-cancerous polyp
3
Adapted from What is Colorectal Cancer? Available at www.healthyroadsmedia.org
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Lesson 8: (GED) Making Important Health Decisions (HANDOUTS)
Page 14 of 26
may grow to a large size, but it will not spread to other body parts. A small
number of polyps (5 to 10 percent) will become cancer if they are not removed
early. But, doctors cannot tell which polyps will become cancer. So to be safe and
prevent colorectal cancer, it is better to find and remove all polyps.
Usually, polyps and early colorectal cancer don’t cause any noticeable
changes in your body. Later, as colorectal cancer grows, people may notice some
problems, or symptoms, like:
•
Blood in or on your stools
•
Going back and forth between hard stool (constipation) and loose
stools (diarrhea)
•
Very thin or narrow stools
•
Feeling bloated or gassy
•
Stomach pains
•
Vomiting
•
Losing weight without trying
•
Feeling tired all the time
These problems or symptoms may be caused by colorectal cancer or other
problems. Check with a doctor if you notice any of them.
Without symptoms, the only way to find polyps or colorectal cancer is to
be tested. If polyps are found, they are usually removed. If the polyps are
discovered to be cancerous, then the treatment may also include radiation,
chemotherapy or other medicines. Cancer is not contagious. You cannot catch it
from someone who has it.
Talk to your doctor about the tests that find polyps early. When they are
found early, they are easier to treat. Things you can do to prevent colorectal
cancer are eating fruits and vegetables every day and exercising often.
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Who Is Likely to Get Colorectal Cancer? 4
Colorectal cancer occurs more frequently in industrialized, Western societies.
It kills more than 55,000 Americans each year. Both men and women can get
colorectal cancer. It is most common in people who are 50 years old or older.
Doctors do not know exactly what causes colorectal cancer. However, there are
some things that increase your risk of developing it.
Your risk increases if:
•
You are 50 years old or older.
•
You or a family member had colorectal polyps or cancer before.
•
You have chronic inflammation of the colon, such as ulcerative colitis or
Crohn’s disease.
•
Your diet is high in fat.
•
Your diet is low in fruits and vegetables.
•
You eat a lot of red meat, especially if it’s grilled, fried or barbequed.
("Red" describes the type of animal meat, not whether it is rare or cooked.
This includes lamb, pork and beef. )
•
You smoke cigarettes.
•
You drink a lot of alcohol.
•
You don’t exercise and you are overweight.
What Can You Do to Prevent Colorectal Cancer?
The most important thing you can do is to be screened for it on a regular
basis when you are 50 years old and older. Be tested at a younger age if you or a
family member have or had colorectal polyps or cancer before; colon diseases,
such as ulcerative colitis or Crohn’s disease, or a hereditary disease that increases
4
Adapted from Who is Likely to Get Colorectal Cancer? Available at
www.healthyroadsmedia.org
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Lesson 8: (GED) Making Important Health Decisions (HANDOUTS)
Page 16 of 26
your family’s risk for certain kinds of cancer. Ask your doctor at what age you
need to be tested and which test is best for you.
People of all ages can do things to help prevent polyps and colorectal cancer:
•
Take a daily multivitamin with “folic acid” or “folate, ” a “B” vitamin that is
found naturally in fruit, vegetable, and rice.
•
Exercise. Try getting at least 30 minutes of physical activity everyday.
•
Eat less red meat, just 2-3 servings per week.
•
Eat 5 or more servings of fruits and vegetables a day.
•
Eat deep fried food less often, and eat fewer fatty foods.
•
Quit smoking.
•
Don’t drink a lot of alcohol.
Doing things to prevent colorectal cancer can protect you and your family against
other diseases, too, like heart disease and diabetes. Follow your doctor’s
recommendations for staying healthy!
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Lesson 8: (GED) Making Important Health Decisions (HANDOUTS)
Page 17 of 26
Colonoscopy 5
Colonoscopy is one type of screening test that doctors use to look for
colorectal cancer. There are a number of different screening tests that can be
used to screen for colorectal cancer, and a doctor may suggest one of the others
based on your situation and the risk factors that you may have. Doctors usually
recommend that people aged 50 and over have screening tests for colorectal
cancer. Colonoscopy allows a doctor to look directly inside your large intestine to
examine the entire colon. The doctor inserts a thin, flexible tube through the
rectum into the colon. A tiny camera at the end of the tube lets the doctor see
inside. If you have a polyp, the doctor will probably remove it during the
colonoscopy. If the polyp cannot be completely removed, the doctor may take a
sample piece (called a “biopsy”) of it to be more closely examined in a lab.
To prepare for the colonoscopy, you have to clean out your colon. This can
include following a special diet and using medication that helps to empty the
colon. This usually takes 1 or 2 days. Doctors often suggest that you stay home
during this time since you will have to use the bathroom a lot.
Right before the colonoscopy, you receive medication to help you relax. After the
test, you cannot drive yourself home, so you will need someone to drive you
home.
There is a small chance of having a serious complication or problem from the
colonoscopy test. There are other tests that look at your intestine, but the
colonoscopy is the most thorough. When you have a colonoscopy test done, you
don’t need to have any other tests to look for polyps or colorectal cancer.
5
Adapted from 5 Tests to Find Polyps and Colorectal Cancer. Available at the Healthy Roads Media
website: http://www.healthyroadsmedia.org/eng.htm
HALL/NCSALL Health Literacy Study Circles+
Skills for Disease Prevention and Screening
Lesson 8: (GED) Making Important Health Decisions (HANDOUTS)
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Skills for Disease Prevention and Screening
Lesson 8: (GED) Making Important Health Decisions (HANDOUTS)
Page 19 of 26
Colorectal Cancer Reading
Comprehension Questions
I. Read the page titled “What is Colorectal Cancer?” and
answer the following questions.
1. The colon is part of what system of the human body?
___________________________________________________
2. What do doctors call the thing created by the growth of uncontrolled cells?
___________________________________________________
3. What are four problems that might mean someone has colorectal cancer?
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
4. What are two things that you can do to help prevent colorectal cancer?
___________________________________________________
___________________________________________________
True or False?
1. The colon is the part of the body where food is
broken down.
T
F
2. Polyps are common in people over 50.
T
F
3. Everyone who has a polyp has cancer.
T
F
4. Colorectal cancer is contagious.
T
F
5. The best way to keep polyps from turning into cancer
is to have a doctor find and remove them.
T
F
HALL/NCSALL Health Literacy Study Circles+
Skills for Disease Prevention and Screening
Lesson 8: (GED) Making Important Health Decisions (HANDOUTS)
Page 20 of 26
II. Read the pages titled, “Who is Likely to Get Colorectal
Cancer?” and “Colonoscopy,” and answer the following
questions.
1. Approximately how many people die each year from colon cancer?
___________________________________________________
2. What are three things that increase a person’s risk of getting colorectal
cancer?
___________________________________________________
___________________________________________________
___________________________________________________
3. Besides the two things you listed earlier in question 5, what are three other
things you can do to reduce your risk of colorectal cancer?
___________________________________________________
___________________________________________________
___________________________________________________
True or False?
1. Only men can get colorectal cancer.
T
F
2. You are at higher risk for colorectal cancer
if someone in your family had colorectal cancer.
T
F
3. If you have a colonoscopy, you will still need
other tests to find polyps or colorectal cancer.
T
F
4. You can tell if you have colorectal cancer
without seeing a doctor.
T
F
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Skills for Disease Prevention and Screening
Lesson 8: (GED) Making Important Health Decisions (HANDOUTS)
Page 21 of 26
Big Decision Game Materials
Influence Statements
Cut out each of the boxes provided below. Distribute a box to each student who
will play the role of an influence in the Big Decision Game. Remind students
that they can make up their own statements, as long they represent the
perspective of the influence that they are assigned.
Personal Views
If you are playing this role, you might say the following:
I hate needles and all that stuff doctors use, and I don’t want anyone
poking around in my behind!
What if I find out I do have cancer? I’m not sure I could handle it.
When you have a colonoscopy done, there is a risk of getting severe
bleeding or a tiny hole in your colon. They say there’s about a 1 in
1,000 chance of that happening – what if I’m the one in a thousand?
Family, Friends, Community
If you are playing this role, you might say the following:
My father’s doctor thinks colon cancer is what killed my dad.
My wife keeps telling me that I should have this test done so she won’t
worry about me.
I want to be around to see my kids grow up.
HALL/NCSALL Health Literacy Study Circles+
Skills for Disease Prevention and Screening
Lesson 8: (GED) Making Important Health Decisions (HANDOUTS)
HALL/NCSALL Health Literacy Study Circles+
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Skills for Disease Prevention and Screening
Lesson 8: (GED) Making Important Health Decisions (HANDOUTS)
Page 23 of 26
Money
If you are playing this role, you might say the following:
If I have this test done, it’s going to cost me $200, even with my
health insurance.
If I get sick and am out of work, how will we pay the bills?
If it turns out I have cancer, how will I be able to support my family?
Work
If you are playing this role, you might say the following:
To prepare for this test, I’d have to drink only liquids for a day or two
and go to the bathroom a lot to clear out my colon. That will mean I’ll
probably have to miss work on the day before, and the day of the test.
My boss won’t be happy about that.
What if I find out I’ve got cancer? They might fire me and then I’ll
lose my insurance, and my family will really be in trouble.
Health Information, Doctors
If you are playing this role, you might say the following:
Doctors think that the most important thing you can do to prevent
colorectal cancer is to get tested for it on a regular basis once you
turn 50.
Having someone in your family who has had cancer increases your
risk of getting colorectal cancer.
A person could have early colorectal cancer and not even have any
symptoms.
HALL/NCSALL Health Literacy Study Circles+
Skills for Disease Prevention and Screening
Lesson 8: (GED) Making Important Health Decisions (HANDOUTS)
HALL/NCSALL Health Literacy Study Circles+
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Skills for Disease Prevention and Screening
Lesson 8: (GED) Making Important Health Decisions (HANDOUTS)
Page 25 of 26
Essay Writing: My Big Decision
Think of an important decision that you once faced in your life.
Write an essay that answers the following questions:
•
•
•
•
•
•
What was the big decision you faced?
What made this decision difficult?
What were the pros and cons of each option?
What was important to you in making the decision?
(e.g., I wanted to do what was best for my children, I
didn’t want to upset anyone, etc.)
What helped you make your decision?
Were you happy with your final decision? Why?
HALL/NCSALL Health Literacy Study Circles+
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Lesson 8: (GED) Making Important Health Decisions (HANDOUTS)
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Page 26 of 26
Skills for Disease Prevention and Screening
Ottawa Personal
Decision Guide
Lesson 8: (GED) Making Important Health Decisions
For Health or Social Decisions
1
What is the decision you face?
____________________________________________________________
The Ottawa Personal Decision Guide is for people who are facing
tough decisions. It will help you identify your personal needs, plan
the next steps, track your progress, and communicate your views to
others involved in the decision. The skills you learn here will also help
you make other decisions in the future.
____________________________________________________________
What is your reason for making this decision?
____________________________________________________________
You will be guided through 5 steps:
1
Clarify the decision.
2
Identify your role in decision making.
3
Assess your decision making needs.
4
Weigh the options.
5
Plan the next steps.
Clarify the decision.
When does this decision have to be made? Date ________________
How far along are you with your decision? [Check ✓ the box that applies to you].
First Time
Changes
Date: ___________ Date: ___________
mm/dd/yy
mm/dd/yy
a. I have not yet thought about options
b. I am considering the options
c. I am close to choosing an option
d. I have already made a choice
The guide can be used more than once to track your progress in
decision making. The first time you use the guide, please place your
answers in the first column. The next time, please use the second
column.
Are you leaning toward a specific option?
If yes, which one? Specify:
2
Yes
No
________________
Yes
No
________________
Identify your role in decision-m
making. [Check ✓ the box that applies to you]
First Time
Changes
Date: ___________ Date: ___________
a. I prefer to decide on my own or after
considering the opinions of others.
b. I prefer to share the decision with:
_________________________.
© 2004 O'Connor, Jacobsen, Stacey, Unversity of Ottawa, Ottawa Health Research Institute, Canada
c. I prefer that someone else decides for
me, namely: _________________.
Reprinted with Permission. Visit http://decisionaid.ohri.ca/decguide.html
mm/dd/yy
mm/dd/yy
Ottawa Personal
Decision Guide
Lesson 8: (GED) Making Important Health Decisions
For Health or Social Decisions
3
Assess your decision-m
making needs.
People make better decisions if they feel confident in four areas: 1. knowing the options; 2. feeling clear about what is important to them; 3. having
enough help from others in deciding; and 4. feeling sure that they are making the best choice.
The questions below can help you see how confident you are in the four areas. Please circle your answers to the questions and date each column.
Changes
First Time
Date _______________ Date _______________
Areas
mm/dd/yy
mm/dd/yy
What I know
What’s
important to me
How others help
How sure I feel
Do you know which options you have?
Yes
No
Yes
No
Do you know the good and bad points of each option?
Yes
No
Yes
No
Are you clear about which good and bad points are most important to you?
Yes
No
Yes
No
Do you have enough support from others to make a choice?
Yes
No
Yes
No
Are you choosing without pressure from others?
Yes
No
Yes
No
Do you feel sure about the best choice for you?
Yes
No
Yes
No
Decisional Conflict Scale ©2004 A. O'Connor
If you answer 'yes' to all the questions in an area, this shows you feel confident. People who have answered 'no' to one or several questions are more
likely to delay their decision, to have trouble sticking with their choice, or to feel regret about their choice or less satisfied with their decision. Therefore,
it is important to work through steps 4 and 5 to gain more confidence in each area.
Reprinted with Permission. Visit http://decisionaid.ohri.ca/decguide.html
Ottawa Personal
Decision Guide
Lesson 8: (GED) Making Important Health Decisions
For Health or Social Decisions
4
Weigh the options.
Use the balance scale below to help you compare the options and, if you wish, show others involved in the decision.
What I Know
A. Please list and review the options you are considering on the balance scale below.
B. List the pros and cons of each option.
C. Underline the pros and cons that you think are most likely to happen.
What is Important to Me
D. Show how important each pro and con is to you by placing one star (*) to five stars (*****) beside each item. More stars show more importance.
How Sure I Feel
E. Circle the option with the pros that are most important to you and most likely to happen. Avoid the option with the cons that are most important to avoid
and most likely to happen.
☺ PROS
Reasons to choose option
Personal
Importance
Add * to *****
CONS
Reasons to avoid option
Option #1 is:
Option #2 is:
Option #3 is:
Reprinted with Permission. Visit http://decisionaid.ohri.ca/decguide.html
Personal
Importance
Add * to *****
Ottawa Personal
Decision Guide
4
Lesson 8: (GED) Making Important Health Decisions
For Health or Social Decisions
Weigh the options. (continued)
F. 'How Others Help Me’.
Complete the table below to keep track of others involved in this decision.
List the persons whose help or
opinions matter most to you
Circle their opinion on the best choice for you
1.
Neutral
Option #1
Option#2
Option#3
2.
Neutral
Option #1
Option#2
Option#3
3.
Neutral
Option #1
Option#2
Option#3
5
Things they can do to help you in this decision
Plan the next steps.
✓ Things making the decision difficult
Not enough information about
options, pros and cons
✓ Things you are willing to try
Having enough information makes it easier to participate in decision making.
List your questions:
List the sources you will use to find this information (e.g. health professionals, librarian at a health centre, Internet, etc.):
Not enough information about the
likelihood of the pros and cons
People make decisions based on their perception of what might happen.
Get advice from your health professional or counsellor about how likely the pros and cons are to happen in your situation.
Unsure about which pros or cons are
most important to me
Finding out what was most important to others who made this decision may help clarify what is important for you.
Talk to your health professional or counsellor about other people who made this decision.
Review stories about others who made this decision (e.g. on the Internet) Whose views match yours?
Talk with people you know who have gone through this decision. Please specify who: _____________________________________________
Lack of support or resources
Support from other people or groups can help your decision making.
List the resources or practical help you still need.
Get advice from a professional you feel comfortable with.
Choose a trusted person who will help you work through the decision.
Bring someone with you to medical or other appointments to take notes.
Pressure from others to make a
specific choice
Focus on the opinions of 'people who matter' in this decision.
Share your decision guide with others.
Ask others to complete a guide themselves. Identify areas of agreement and differences. (People usually can agree on the facts, but may
differ on what they value most. It is the person who will be most directly affected by the choice whose values matter most).
Find a neutral person to help you and others find solutions to the disagreement.
Other factors making the decision
difficult
List anything else you need to help you:
Reprinted with Permission. Visit http://decisionaid.ohri.ca/decguide.html
Ottawa Personal
Decision Guide
Lesson 8: (GED) Making Important Health Decisions
For Health or Social Decisions
If you would like to share this information with your health practitioner or other health professional, please
complete this section with some information about yourself.
Current Date:
______________________________
dd/mm/yy
Last Name:
______________________________ First Name : _____________________________
Year of birth:
______________________________
Sex:
male
Highest completed education:
grade school
elementry school
some high school
high school diploma
community college diploma
university degree
Language most often spoken
at home:
Ethnic origin:
Medical conditions
that might affect your
decision:
Please rate your health:
Family composition
(Who lives at home with you?)
female
______________________________
______________________________ (e.g. Caucasian, Asian, African, Hispanic)
______________________________
excellent
good
fair
poor
Discuss your options and views with your
health professional or counsellor.
Before making a final decision, discuss your
situation with your health professional or
counsellor. Every individual’s needs and health
concerns are different.
______________________________________
Address :
______________________________________
______________________________________
Telephone number:
( ______ ) _____________________________
Reprinted with Permission. Visit http://decisionaid.ohri.ca/decguide.html
For additional copies of this decision aid and an
interactive version, visit www.ohri.ca/decisionaid
Lesson 9: (ESOL) Introduction to Informed Consent
Page 1 of 14
Lesson 9: (ESOL) Introduction to Informed Consent
Prevention and Screening Tasks
Addressed in This Lesson
ƒ Become familiar with the nature
and purpose of informed consent
forms
ƒ Get help to understand
information on official forms and
documents
Skills Focus
ƒ Students will share and discuss
personal perspectives on official
documents and forms used in
everyday life.
ƒ Students will learn vocabulary
typically found on informed
consent forms.
ƒ Students will strengthen oral
communication skills needed to
ask questions and request help
when they want more
information from their doctors
about tests and procedures.
ESOL Level
Intermediate to advanced
Time
Approximately 4 hours
(or 2-3 class sessions)
Materials
Student handout
Key Vocabulary
benefits
capacity
coercion
duress
grant
informed consent
patient rights
risks
test
treatment
voluntarily
HALL/NCSALL Health Literacy Study Circles+
Purpose
This lesson is designed to introduce ESOL
students to the nature and purposes of informed
consent forms in health care. The lesson is
organized around four readings, which describe
the concept and purpose of informed consent
forms. After each reading, students complete
an exercise that either reinforces new
vocabulary or provides them with an
opportunity to talk about the nature of
informed consent.
Steps
Prepare for the lesson. Copy and distribute
the Introduction to Informed Consent handout
(Parts A and B). Teaching notes for each part
are provided below.
PART A: Introduction to Informed Consent
1. Pair Work
Ask the students to find a partner to
complete Part A on the handout. As the
directions on the handout indicate, the
pairs are asked to look over the list of
official documents and forms in the chart
and check which ones they know about
and which ones they have actually signed
before. This pair work provides students
with an opportunity to share their
experiences with official forms and
documents and to identify barriers to
understanding these forms. When pairs
have finished, invite 1-2 students to share
their experiences with forms and
documents.
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Lesson 9: (ESOL) Introduction to Informed Consent
Page 2 of 14
PART B: Introduction to Informed Consent
1. Reading #1
Say to the students, “We have just talked about lots of different kinds of official
documents and forms. Now we are going to focus on one kind of form that doctors
often use. It is called an informed consent form.”
Write “informed consent form” on the board. Say to the students, “Do not worry if
you do not know what this means. We will now read something that will teach you
about informed consent. Let’s begin.” Tell the students to look at Reading #1 in Part
B.
You can do a model reading of Reading #1. Next, ask for a volunteer to read the text
again. Then, ask the students to explain to a partner what the passage is about. This
retelling can be useful for students who need the opportunity to practice new
vocabulary and build self-confidence in reading fluently. Once students have a
working idea of what the reading is about, you may wish to practice reading the text
in different ways: choral reading (reading the text aloud together); echo reading (the
teacher reads a line and all the students repeat the line back to the teacher); peer
reading (students work in pairs to take turns reading the text).
2. Vocabulary Study
This exercise is meant to reinforce the students’ comprehension of the new
vocabulary words learned in Part A. The students are asked to look closely at the
words informed and consent and to think of words that are related in form and
meaning. This exercise builds the students’ knowledge base and taps into any prior
knowledge they may have of these words.
Note also that students may be able to identify cognates for the words informed and
consent in their first language. (Cognates are words in two languages that have a
common ancestral origin and thus are similar in spelling and/or meaning. Inform in
Spanish is informar; consent in Spanish is consentimiento). To strengthen students’
vocabulary knowledge, invite students to share any cognates of these new words with
the class.
3. Check Your Understanding
An important step after Reading #1 is asking students to define in their own words
what they think informed consent means. This step provides you (the teacher) with an
important comprehension check. It also will be useful for students who need practice
using new vocabulary. If appropriate, you may wish to encourage students from
similar first-language backgrounds to work together at this point so that they can
utilize their first language to confirm and clarify their understanding.
Note to teacher: Reading #1 contains the words “risks” and “benefits,” words that
may be unfamiliar to students. Understanding these words is important if the students
are to fully appreciate the meaning of “informed consent.” Be sure to check the
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students’ comprehension of these words before going on to Reading #2.
4. Reading #2 and Discussion
You (the teacher) can do a model reading of Reading #2. As with Reading #1, ask for
a volunteer to read the text again. Then ask the students to explain to a partner what
the passage is about. Practice reading the text in a way that suits your class: e.g.,
choral reading (reading the text aloud together); echo reading (the teacher reads a line
and all the students repeat the line back to the teacher); peer reading (students work in
pairs to take turns reading the text).
Be sure that in your model readings of Reading #2, you emphasize the words “the
moral and legal right to make decisions,” because these words are the focus of the
discussion immediately following Reading #2. The students are asked to say what
they think the phrase “the moral and legal right to make decisions” means. To guide
discussion, ask students, “What is a moral right? What is legal right? Why is
informed consent a moral and legal right?”
Note: A legal right is a right that is protected by the law of the government. A moral
right is a right that people believe all humans should have. Moral rights are not
protected by the law. People do not always agree on what is a moral right.
The students are asked to complete a sentence prompt that makes use of the phrase
“moral and legal right.” This task is meant to reinforce their understanding of these
important words.
Ask for volunteers to share their completed sentences with the rest of the class.
5. Reading #3, Vocabulary Study, and Discussion
Again, as with previous readings, you (the teacher) can do a model reading of
Reading #3. Ask for a volunteer to read the text again. Then ask the students to
explain to a partner what the passage is about. Practice reading the text in a way that
suits your class: e.g., choral reading, echo reading, or peer reading, as described
above.
After the students finish reading Reading #3, they focus on some legal words
commonly used on informed consent forms. The chart, which compares Legal Talk
versus Everyday Talk, shows the students how the legal words can be “translated”
into everyday words. The vocabulary focus and accompanying discussion questions
help students think critically about the language used on medical consent forms. This
critical look at language can help students talk about how the language of the medical
world is a barrier to health care. Students have the opportunity to talk about issues of
language and power. For example, the students may want to talk about the underlying
assumptions – the “unspoken” messages – about who is in control of health care
decisions. Lawyers and doctors may have more control because they decide what
information to put on these forms, and patients may not feel in control if they cannot
understand the information that is given to them. From this kind of discussion,
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students are then given an opportunity to identify coping strategies – action steps they
might take if they didn’t understand a word on an informed consent form (e.g., ask for
a trained interpreter, ask the doctor a lot of questions).
6. Reading #4 and Discussion.
As with previous readings, you (the teacher) can do a model reading of Reading #4
Ask for a volunteer to read the text again. Then, ask the students to explain to a
partner what the passage is about. Practice reading the text in a way that suits your
class.
Allow 20 minutes for partners to discuss the questions that follow the reading. These
questions are meant to check students’ comprehension of two main ideas from
Reading #4. One, students should understand that asking questions of your doctor
about tests and treatment is important; asking questions before you have a test or
treatment is the best time to ask questions. Remind students: if you don’t ask
questions, your doctor may think you understand. Two, students should understand
that you can still ask questions after you sign a consent form. You can also change
your mind about a test or treatment even if you have signed a form. Signing the form
does not mean you HAVE to have a test or treatment.
Follow-up Activities
A. Personal “health care dictionaries.” The creation of a vocabulary log can be carried
out individually or in small groups. Students are asked to create their own
“dictionaries” for studying the new vocabulary presented in the readings on informed
consent. The dictionaries can include key words chosen by the instructor as well as
words that the students want to remember. Encourage the students to include first
language translations, pictures, and sample sentences for each entry. This project can
be used to launch the creation of personal “health care dictionaries,” where students
can record any new words related to health care that come up in class. Students can
use their dictionaries for self-study or exchange dictionaries with a partner to learn
more new words.
B. Looking at informed consent forms. Gather sample informed consent forms from
hospitals and doctors’ offices. Students can also ask their doctors for sample informed
consent forms. In class, form small groups to look at the consent forms. Ask the
students: Are these forms clear? What is easy to understand? What is difficult to
understand? Are these forms written in other languages besides English? What should
doctors do to make these forms clearer and easier to read?
C. Role-play. Tell the students: “You are a patient. Your doctor gives you an informed
consent form. You do not understand what the form is about. What can you ask the
doctor?” Write a short skit between the patient and the doctor. Practice your skit.
Perform your skit for the whole class.
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D. Guest speaker series. Invite a doctor and/or a medical lawyer to talk to the class
about informed consent forms. Students can work together to write a letter of
invitation to a particular doctor, local clinic, or legal office inviting someone to come
speak to their class. Students can prepare questions in advance. After a guest speaker
event, students can summarize what they learned and share their notes with other
students in the adult education program.
E. Multilingual resource guide on informed consent. Students can create a resource
guide on informed consent forms to share with other adult ESOL students. The guide
can explain in English and in their first language what informed consent forms are,
why they are important in health care, and what patients can do if they do not
understand information their doctors give them.
Adaptations for ABE/GED settings
Our advanced ESL as well as native-English speaking students are also likely to experience
difficulties understanding and reading informed consent forms. To make the lesson more
challenging for more advanced students, you may wish to assign two of the four reading
texts at a time and ask the students to write a written response as well as discuss the
readings in small groups. Ask students to choose 5-6 words they really want to remember
from these readings. In pairs, students can work together to create a lesson activity that
teaches the words to the rest of the class. Encourage the students to use visual props (e.g.,
transparencies that can be displayed on an overhead projector). Challenge the students to
come up with creative ways to teach the words to their peers. Some possible activities the
students might use include: role plays and skits, games, crossword puzzles, vocabulary
quizzes, use of songs, or picture prompts.
Technology Tips
9 National Cancer Institute, A Guide to Understanding Informed Consent
http://www.cancer.gov/clinicaltrials/conducting/informed-consent-guide/
This lesson drew information about informed consent from this useful website.
The website is designed for researchers and doctors but features information (e.g.,
myths and realities about the nature of informed consent) that practitioners may
find useful for creating lesson materials or for background information.
9 eMedicineHealth.com, Patient Rights: Informed Consent
http://www.emedicinehealth.com/articles/12033-3.asp
This lesson also drew information about informed consent from this website that
is more reader-friendly than the NCI site listed above.
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Skills for Disease Prevention and Screening
Lesson 9: (ESOL) Introduction to Informed Consent (HANDOUTS)
Page 7 of 14
INTRODUCTION TO INFORMED CONSENT
A. Pair Work.
Look at the chart below. Have you seen these
documents or forms before?
Which ones do you know about? Which ones have you
read and signed before? Check 5 the appropriate
boxes.
Find a partner and talk about your answers.
Add other official documents and forms that you and
your partner know about.
I know about
this one.
I have read and
signed one before.
Employment contract
Lease agreement
Informed consent form
Document or form
School permission form
Have you ever had problems reading official documents and forms? What
happened? What did you do?
Share your answers with your partner.
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B. Read and study. Focus on “informed consent” in health
care.
Reading #1.
Please read the text in the box below.
In the United States, doctors must give you, as a patient, information
about a particular treatment or test so that you can decide whether or not
to have the treatment or test. This process of understanding the risks and
benefits of a treatment or test is known as informed consent. When you
sign an informed consent form, you are telling the doctor that you
understand the information about a treatment or test.
Vocabulary Study. You can learn words by learning other words that have
similar form and meaning (sometimes called derivatives). For example, let’s look
at the words “informed consent”. What does “to inform” mean?
Some common derivatives of inform are information, informed, informative,
and informant. Some derivatives of consent are consensus and consensual.
These words are different parts of speech but share common meanings.
Study these words in the chart on the next page. Write down their meanings.
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Lesson 9: (ESOL) Introduction to Informed Consent (HANDOUTS)
Part of speech
Noun
Word
information
Page 9 of 14
Meaning
informant
consensus
Adjective
informative
informed
consensual
Verb
inform
Check your understanding. In your own words, explain what informed
consent is.
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Reading #2.
Please read the text in the box below.
The process of informed consent is very important to your health care because
you, as the patient, have the moral and legal right to make decisions about
your own health and medical conditions.
Talk with a partner.
This paragraph says, “You, as the patient, have the moral and legal right to make
decisions about your own health and medical conditions.”
What does this sentence mean to you? Do you agree with this sentence? Explain.
Complete the sentence below with your own idea.
In today’s society, I think that people have the moral and legal right to
_________________________________________________
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Reading #3.
Please read the text in the box below.
There are four key parts of an informed consent process:
1. You must have the capacity to make the decision. This means you must be
able to make the decision.
2. The doctor must give you information about the treatment or test. The
doctor must tell you about the possible benefits and risks, and the likelihood
that the benefits and risks will happen.
3. You must be able to comprehend the information the doctor gives you.
4. You must voluntarily grant consent. This means that you have the right to
make your own decision about the treatment or test. No one can force you to
make a certain choice (this is coercion). No one can threaten you to make a
certain choice (this is duress). These actions are against the law.
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Vocabulary Study: Legal Talk versus Everyday Talk.
When doctors and lawyers talk about informed consent, they often use words
that can be hard to understand. They may use legal words that are not used
in everyday talk.
Compare these lists.
Legal Word
Everyday Word
coercion
duress
to grant
voluntarily
to consent
to inform
force
an unfair threat
to give
by choice
to agree
to tell
Talk to your partner. Why do you think everyday words are not used on
informed consent forms?
If you didn’t understand a legal word on an informed consent form, what
would you do?
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Reading #4.
Please read the text in the box below.
The difficult language in informed consent forms
can make it very hard for a patient to understand
important information about a treatment or test.
Before you sign, you should ask questions about
the treatment or test. After you sign, you can still
ask questions. You can also change your decision.
Remember: keep asking questions until you have
all the information you need to make a good
decision.
Talk to your partner.
1. Why is it important to ask questions of your doctor?
2. Can patients ask questions after they sign an informed consent form? Why
is this important?
3. Can patients change their mind about having the test or treatment after
they sign an informed consent form? Why is this important?
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Skills for Disease Prevention and Screening
Lesson 10: (ESOL) How Likely is Likely?
Vocabulary for Talking about Probability
Page 1 of 18
Lesson 10: (ESOL) How Likely is Likely? Vocabulary for
Talking about Probability
Disease Prevention and Screening
Tasks Addressed in this Lesson
ƒ Be familiar with words that doctors
often use to talk about likelihood
and probability (e.g., likely, rare,
certain)
ƒ Ask doctors questions about health
risks
Skills Focus
ƒ Students will learn a range of
adjectives that are used to convey
likelihood and probability.
ƒ Students will explore how words
differ in the degree to which they
convey the certainty of events.
ƒ Students will explore ways that
people interpret the same word
differently based on context.
ABE/ESOL Level
High beginning to low-intermediate
ESOL
Time
2 60-minute sessions
Materials
Handout (9 pages)
Key Vocabulary
risk
likely
unlikely
rare
impossible
possible
equal chance
Purpose
This lesson is designed to familiarize
students with the range of words that doctors
often use to convey likelihood and
probability. This lesson is organized around
a series of pair-work exercises. These
exercises introduce students to new
vocabulary (e.g., likely, rare) and then
provide multiple activities in which to apply
this vocabulary knowledge. These exercises
are intended to show students that the
meaning of words such as likely and rare
often differ from person to person, and thus
it is critical that students feel prepared to ask
their doctors what these words mean in terms
of individual health risks and outcomes.
Steps
1. Preparation. Distribute a copy of the
handouts beginning with What is likely
to happen? (pages 7-14). Organize the
students into pairs.
2. Pairwork: The handout for this lesson
features 8 exercises for the pairs to
complete.
ƒ
certain
probable
definite
fifty-fifty
improbable
out of the question
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Exercise 1: Warm-up
This conversation activity asks
students to talk about the activities
they do in everyday life that
involve likelihood and probability,
e.g., playing the lottery. This
warm-up introduces the lesson’s
theme. Note: there is no critical
need to introduce the terms
likelihood or probability. To
simplify the lesson’s focus, it’s fine
to use a word such as chance or a
phrase like Will it happen or not?
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Lesson 10: (ESOL) How Likely is Likely?
Vocabulary for Talking about Probability
Page 2 of 18
ƒ
Exercise 2: Vocabulary Study
This section introduces a set of words that convey likelihood or probability on a
scale that shows how they range in meaning from “It will never happen” to “It
will definitely happen.” Read the words aloud so that students can hear a model
reading. Encourage students to use their dictionaries or translate the words into
their first language, if necessary.
ƒ
Exercise 3: Vocabulary Practice
This exercise asks the students to apply their knowledge of the new vocabulary
words. The students are asked to think of things in their everyday lives that are
“likely” or “rare” and so forth.
ƒ
Exercise 4: Vocabulary Practice: Will it happen?
Like exercise #3, this exercise also asks the students to apply their knowledge
of the new vocabulary words. Unlike the previous exercise, which used the new
vocabulary words in general life contexts, this exercise uses the words in healthrelated contexts. Students are asked to think about the likelihood of eight
different events. Each student writes down his or her own response using one
of the new vocabulary words (e.g., likely, not likely, impossible). Then, each
student finds a partner to compare responses. This exercise encourages students
to see how people differ in their perceptions of “what is likely to happen.” Our
decisions about “what is likely to happen” are a combination of fact (hard facts,
cold evidence) and feeling (what we believe and feel might happen).
Note to teacher: Most of the situations in exercise #4 are open to interpretation
and do not have a “correct” answer. For example, in the first situation about
playing the lottery, one person may feel it is likely that Pablo will win the lottery
while another person may feel it is impossible. This exercise provides students
with an opportunity to talk about these differences in interpretation. Situations
#3 and #8, however, have correct answers.
ƒ
•
About situation #3: When you flip a coin, there are only two possibilities
– heads or tails, so there is an equal chance that a flip will result in
heads.
•
About situation #8: Similarly, with the sex of a baby, there are only two
choices, boy or girl, so there is an equal chance that it could be a girl.
Exercise 5: Vocabulary Study - Words with similar meanings
In this exercise, students learn synonyms for the words that were introduced in
exercise 2. Students are asked to add these words to the scale. This provides
students with an opportunity to check their understanding of the words’
meanings.
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Lesson 10: (ESOL) How Likely is Likely?
Vocabulary for Talking about Probability
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ƒ
Exercise 6: Vocabulary Study: Adverbs that go with “likely” and
“unlikely”
This exercise teaches the students a few adverbs that are commonly used with
the terms likely and unlikely. If you wish, you may want to ask students to add
these phrases to the scale in Exercise 2 as well. This shows students another
way to convey differences in likelihood.
ƒ
Exercise 7: Picture Story: What does ‘likely’ really mean?
This exercise is meant to help students think about how challenging it can be to
figure out what a doctor means when she/he uses words like ‘likely’ and ‘rare.’
This exercise is also meant to help students think about the kinds of questions
they can ask doctors to better understand what they mean when they say
“likely” or “unlikely.” Ask the students to practice reading the conversation
between the doctor and patient out loud. After students have had a chance to
look at the picture story, they work in pairs to answer the questions at the end of
the story.
Story Overview: A man goes to see his doctor because he keeps getting
headaches. The doctor does an examination and tells the man that the cause is
likely stress. She also says that the cause could be a tumor but this is unlikely.
However, she tells the man that she wants to do more tests just to make sure.
The man says okay and goes home. At home he starts to think about what the
doctor said. He did not understand what the doctor meant by ‘likely’ and
‘unlikely.” He is confused. He is afraid that he may have a tumor.
Here are some discussion prompts for beginning-level students who may need
help comprehending the story:
Frame 1: What is the man saying? What is he feeling? Who is he speaking
to? Where are they? (Follow up: What is the doctor doing?)
Frame 2: What is the doctor saying? What will the doctor do next?
Frame 3: When is this happening? Why is the man in different clothes?
What is the doctor saying? What is the man doing?
Frame 4: Now, what is the doctor saying? What is the man thinking? What
is he feeling? Why? (Follow-up: Has a doctor ever told you something about
your health that made you worried or scared? What did you do?)
Frame 5: What is the doctor saying? What does the man say? What do you
think the man is thinking? What do you think he is feeling? Why?
Frame 6: Where is the man now? What is he saying? What do you think he
is feeling?
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Vocabulary for Talking about Probability
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After discussing Frame 6, emphasize to the students that it is not always clear
what doctors mean when they say “likely,” “unlikely,” or other related words.
In fact, one study (Bryant & Norman, 1980) asked a group of doctors to say
what “likely” meant in terms of numbers. They gave a range of anywhere
between 40% and 75%!
Be sure that students understand the basic plot of the story before they answer
the following discussion questions, which follow the story.
1. What happens in this story? Use your own words and tell the
story to your partner.
2. What is the man thinking when he goes home after the exam? What do
you think he is feeling? Why?
3. If this man were your friend, what would you tell him?
4. Has this experience ever happened to you? What did you do?
5. What kinds of questions can we ask a doctor if she or he talks about a
health problem that is likely or unlikely to happen?
ƒ
Exercise 8: Understanding information about health risks
This exercise provides an additional context for students to practice using the
probability vocabulary. The teacher can organize the students into pairs or
small groups to focus on one of the 3 tasks in Exercise 8. In pairs or small
groups, students look at the pictures or graphs and fill in the blanks in the
sentences that describe the pictures/graphs. The teacher can then facilitate a
large group discussion in which each pair/small groups shares their answers.
The teacher can also invite students to talk about whether the picture/graph
made it easy to understand the message about risk. Also, note that the jar of
marbles, the bar graph, and the line graph are common ways that doctors and
health officials convey risk information to the public, so this exercise provides
the students with an opportunity to develop important document literacy skills
as well.
Follow-up Activities
A. Short reading with journal writing. Ask students to read “How likely is likely?”
(found on page 15 of the student handouts) for homework or in class. This reading is
about the lack of clarity around probability words such as “likely” and “unlikely,” a
topic that was addressed in the picture story in exercise 8. You may wish to assign
this reading for homework or for in-class reading, and then discuss the questions as a
whole class. You may also wish to ask the students to spend some time responding to
the discussion questions in their journals.
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Vocabulary for Talking about Probability
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B. Interview practice. Ask students to show the picture story used in this lesson to one
person outside class (a family member, a friend, co-worker). The student will then
interview the person about what he/she thinks is going on in the story, using similar
prompts to those used in the lesson. Students can ask the following questions (or
make up their own):
1. What is the man thinking when he goes home after the exam? What do you
think he is feeling? Why?
2. If this man were your friend, what would you say to him?
3. Has this experience ever happened to you? What did you do?
Ask students to share their interview responses in class. As a group, talk about similarities
and differences in peoples’ responses.
Technology Tips
9 The picture story in this lesson is based on work by Kate Singleton, who has
created a series of pictures stories for use in the adult ESL classroom. A link to
Singleton’s work can be found at Web site noted below:
Singleton, K. (2002). Picture Stories for Adult ESL Health Literacy. Article and
lesson materials available at the home page for the Center for Adult English
Language Acquisition, http://www.cal.org/caela/ (Accessed April 3, 2006)
9 Does your class want to talk more about the pros and cons of playing the lottery?
Here is a link to an interesting feature produced by PBS and the television
program Frontline. The link focuses on the California Lottery and is found at
http://www.pbs.org/wgbh/pages/frontline/shows/gamble/odds/california.html
(Accessed April 3, 2006)
References
Information in the following sources was adapted for use in this lesson:
•
Bryant, G. D., & Norman, G. R. (1980). Expressions of probability: Words and
numbers. New England Journal of Medicine, 302(7), 411.
•
Cohn, L.D., Schydlower, M., Foley, J., & Copeland, R.L. (1995). Adolescents'
misinterpretation of health risk probability expressions. Pediatrics, 95, 713-716.
•
Lipkus, I.M., & Hollands, J.G. (1999). The visual communication of risk. Journal
of the National Cancer Institute, 25, 149-63.
•
McCarthy, M. & O’Dell, F. (1994). English vocabulary in use. Cambridge, UK:
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Lesson 10: (ESOL) How Likely is Likely?
Vocabulary for Talking about Probability
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Cambridge University Press. [Lesson 60 on Obligation, need, possibility, and
probability]
•
Redman, S. (1997). English vocabulary in use: Pre-intermediate and
intermediate. Cambridge, UK: Cambridge University Press.[Lesson 32: Adverbs,
frequency and degree]
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Vocabulary for Talking about Probability (HANDOUTS)
Page 7 of 18
What is likely to happen?
X Warm up. Look at the activities below. Circle the activities that you like to do.
play the lottery
play poker
read fortune cookies
read horoscopes
invest in the stock
market
bet on sports teams
Talk to a partner.
Ask questions about your partner’s choices. For example, Why do you like to play
the lottery?
YVocabulary Study.
The picture below shows a scale with words that you
can use to talk about how likely it is that something will happen. Practice
saying these words. Use a dictionary if you need help with their meanings.
“It will never
happen.”
impossible
“It will
definitely
happen.”
rare
unlikely
Z Vocabulary Practice.
•
•
•
•
•
•
•
equal
chance
possible
likely
certain
Think of something in today’s world that…
is certain to happen.
is likely to happen.
is possible.
has an equal chance of happening.
is unlikely to happen.
is rare.
is impossible.
Share your ideas with others in your class.
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Lesson 10: (ESOL) How Likely is Likely?
Vocabulary for Talking about Probability (HANDOUTS)
Page 8 of 18
[ Vocabulary Practice: Will it happen? Read the situations below.
Decide
how likely each situation is. Use the adjectives from Y in your answer. For
example, write rare or impossible or likely. Write your idea in the column
“Your answer.”
Find a partner and ask for his or her ideas. Write down his or her responses.
Your
answer
c
You will win the lottery someday.
d
You flip a coin. It will turn up heads.
e
It will snow in the Amazon rainforest.
f
Maria got the chickenpox vaccine when she was
a baby. She will get chickenpox as an adult.
g
Andre smokes a pack of cigarettes a day. He will
have health problems when he is older.
h
Martin exercises three times a week, eats a
healthy diet, and is not overweight. Martin will
get diabetes.
i
Greg’s father has cancer so Greg will also have
cancer.
j
Lian is pregnant. She will have a baby girl.
Your
partner’s
answer
Share your answers with a partner. Compare. How are your answers the
same or different?
\ More Vocabulary Study: Words with similar meanings.
Below is a
list of words that have similar meanings to words shown in Y.
Which of these words mean unlikely? Which words mean more likely? Add
these words to the scale near the words that have the same meaning.
If you need help, use your dictionary or ask your teacher or a classmate for
help.
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Page 9 of 18
definite
yes or no
out of the question
fifty-fifty chance
maybe
not possible
probable
not probable
improbable
Compare your scale with someone else’s scale to check your understanding of
the word meanings.
]
More Vocabulary Study: Adverbs that go with ‘likely’ and
‘unlikely.’
If you feel strongly that something will or will not happen, you can say:
very or highly likely
very or highly unlikely
Also, note that:
not likely at all = unlikely
If you feel less strongly that something will or will not happen, you can
say:
somewhat likely
somewhat unlikely
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Vocabulary for Talking about Probability (HANDOUTS)
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Skills for Disease Prevention and Screening
Lesson 10: (ESOL) How Likely is Likely?
Vocabulary for Talking about Probability (HANDOUTS)
^ Work with a partner.
Page 11 of 18
Look at these pictures. Discuss the questions on the
next page.
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Lesson 10: (ESOL) How Likely is Likely?
Vocabulary for Talking about Probability (HANDOUTS)
Page 12 of 18
Questions about the story
Discuss the following questions with your partner.
1. What happens in this story? Use your own words and tell the story
to a partner.
2. What is the man thinking when he goes home after the exam? What
is he feeling? Why?
3. If this man were your friend, what would you tell him?
4. Has this experience ever happened to you? What did you do?
5. What questions should this man ask his doctor?
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Vocabulary for Talking about Probability (HANDOUTS)
_
Page 13 of 18
Understanding information about health risks. Sometimes
doctors use pictures and graphs to help their patients understand what is
likely or unlikely to happen to their health. Here are some examples.
Work with your partner. Look at each picture or graph. Work together to
complete the sentences, using the words in the boxes.
Example #1
Risk of Getting Disease X
= will not get
Disease X
= will get
Disease X
If we picked a marble from this jar, it is more
unlikely
____________ that we would pick a_________
black
marble from the jar than a ___________marble. This
likely
means that it is _________ that we would get Disease
white
X.
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Example #2
15
RISK OF
GETTING
DISEASE X
(%)
10
5
0
MEN
WOMEN
GENDER
This graph shows that the risk of getting Disease X is not
likely
the same for ___________ and ___________.
five
Women have a _________ percent chance of getting
men
Disease X, while men have a _________ percent
women
chance of getting Disease X. This suggests that men are
ten
less __________ to get Disease X compared to women.
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Vocabulary for Talking about Probability (HANDOUTS)
Page 15 of 18
Example #3
40
30
RISK OF
GETTING
DISEASE X
(%)
20
10
0
25
35
45
55
65
75
AGE
This graph shows that you are more ___________ to
55
get Disease X as you get ___________. If you are
likely
___________, you have about a ___________
25
percent chance of getting Disease X.
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Lesson 10: (ESOL) How Likely is Likely?
Vocabulary for Talking about Probability (HANDOUTS)
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Skills for Disease Prevention and Screening
Lesson 10: (ESOL) How Likely is Likely?
Vocabulary for Talking about Probability (HANDOUTS)
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Reading assignment: How likely is likely?
Read the paragraph and answer the questions below.
Imagine you are at the doctor’s office. The doctor says to
you, “You must exercise more and eat a better diet. If you
don’t, you are likely to get diabetes.” The doctor is talking
about your risk of getting diabetes. Risk is the possibility
that something bad or dangerous will happen. But what
does the doctor mean by likely? If you don’t exercise and
eat better, it doesn’t mean you’ll definitely get diabetes.
And if you do exercise and eat a better diet, you may still
get diabetes. How confusing!
Doctors often use words such as rare, likely, and
unlikely, but they don’t realize that patients don’t always
understand what they mean.
If you don’t understand
something, ask your doctor to explain it to you. Remember, it
is impossible to predict exactly what will happen with our
health. But if you make sure you understand the words the
doctors use, you have a better chance of taking good care of
your health.
1. What does the word “risk” mean to you?
2. Why are words such as likely often difficult to understand?
3. Have you ever talked to your doctor about your health risks? What
happened?
4. What things can you do to make sure you understand your own health
risks?
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Skills for Disease Prevention and Screening
Lesson 11: (ABE) Introduction to Probability
Page 1 of 26
Lesson 11: (ABE) Introduction to Probability
Disease Prevention and
Screening Task
Addressed in this
Lesson
ƒ Understand health
messages that are
based on probabilities
Skills Focus
ƒ Students will practice
calculating
probability and
estimating likelihood.
ABE/ESOL Level
Intermediate ABE
Time
2 hours
Materials
Handouts
Coins for flipping
(1/pair)
Paper bags (1/pair)
Colored balls or candy
(1 set of 20/pair)
Key Vocabulary
even chance
event
fifty-fifty
likelihood
outcome
probability
randomly selected
chance
odds
risk
statistician
weighted chance
Purpose
This lesson is designed to provide students with an
introduction to the concept of probability. It includes handson activities to help students build understanding and
calculate probability.
Prerequisites
This lesson assumes that students have some familiarity
with fractions. Students are asked to understand fractions as
expressions of probability; however no computation with
fractions is required.
Steps
1. Introduce the concept of probability (Large group
discussion)
Show students the following list of statistics related to
health risks. (You may wish to write the statistics on the
board, or create an overhead or handout to share this
information. Note that you will revisit these statements
later in the lesson.)
The American Cancer Society reports the following 1 :
Among women aged 40 to 59, the risk of developing
breast cancer is 1 in 24.
For women up to age 39, the risk is 1 in 207.
Among men aged 40 to 59, the risk of developing
prostate cancer is 1 in 39.
For men up to age 39, the risk is 1 in 9879.
Ask students the following questions:
Have you seen these kinds of statements before?
Where?
(e.g., newspapers, doctors’ offices, magazines, etc.)
What do you think when you see them?
(e.g., They seem scary, I don’t understand)
What makes them difficult to understand?
(e.g., too many numbers, etc.)
1
Note: These statistics were reported as of February 2006 at
http://www.cancer.org/downloads/STT/CAFF2005f4PWSecured.pdf. These statistic may change
periodically; therefore you may wish to update them with information from the statistics section of the
American Cancer Society website.
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Point out that the idea behind these kinds of statements is something known as
“probability”.
ƒ The word “probability” refers to how likely or unlikely it is that something
will happen.
ƒ We sometimes refer to probabilities as the chances or odds of something
happening.
Explain that we use probabilities to tell us how likely a particular outcome is to occur
for a particular event. Clarify these terms with the examples listed below.
ƒ
An event can include things such as getting a gift, having a traffic-free
morning commute, or having a snowstorm in your town. An event can also
be 2 :
A coin toss
Rolling a die or rolling two dice
Drawing a card from a deck of cards
Drawing a marble from a bag of different colored marbles
Spinning a spinner on a board game
Playing the lottery
Having a baby
ƒ
An outcome is the result of an event like those just described above.
For instance, a coin toss has two possible outcomes – heads and tails.
Rolling a regular six-sided die has six possible outcomes – 1,2,3,4,5 or 6.
Drawing a card from a deck of cards has 52 possible outcomes – since
each card is different.
Playing the lottery has two outcomes – winning or losing.
Having a baby typically has two outcomes – a boy or a girl – but can also
have outcomes like twins, triplets, etc.
ƒ
The probability of an outcome for a particular event is a number that tells us
how likely a particular outcome is to happen. Lower probabilities mean that
events are less likely, while higher probabilities mean that events are more
likely.
For example, when I roll a die (an event), how likely is it that I will roll a 3 (a
particular outcome)?
The probability of this outcome is the ratio of the number of ways I can roll a
3 (only one way) divided by the number of total possible outcomes when I roll
a die:
2
Adapted from What is an event? available at:
http://www.mathleague.com/help/percent/percent.htm#whatisanevent.
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6
Page 3 of 26
(only one way to roll a three with only one die)
(the total number of outcomes possible when I roll a die)
(Note: If students are feeling confused at this point, let them know that you will do
some activities in this lesson to make the idea of probability clearer.)
Explain what is meant by health outcomes.
ƒ
ƒ
ƒ
Health outcomes include a broad range of things, including giving birth to a
healthy baby, living to 90, getting cancer, or having a heart attack.
When medical people talk about the chance or risk of health outcomes, they are
really talking about probabilities of these outcomes occurring. They are referring
to how likely it is, for example, that someone will develop a certain disease.
When doctors and other health professionals discuss health risks with a patient,
they are using two sets of information.
• Health Statistics. To understand health risks, doctors rely on what
researchers have found out about how many and what types of people get
certain diseases (e.g., men, women, smokers, older people, etc). Health
statistics may also differ based on geography (country or city) and
environmental factors (being exposed to things like pollution, chemicals).
• Individual Factors. Next, doctors need to know about each patient. For
example, they must consider a person’s age, current health, test results,
exposures and behaviors, and family history.
Explain to students that they will now take part in some activities to help them
understand probability and to make better sense of health messages about disease
risk.
2. Coin Flipping 3 (Large Group discussion and small group work)
This activity uses the process of flipping a coin to help students understand a basic
probability of 1 in 2 or a fifty-fifty chance.
Tell students that you will now look at a common example of probability with which
students may be familiar – tossing or flipping a coin. Ask students the following
questions:
How many of you have ever flipped a coin?
Why do people flip coins?
What are the possible outcomes?
Is flipping coins a fair game? Why?
3
This activity is adapted from Probability Games. Statistics in Your World, available at:
http://www.rsscse.org.uk/pose/level1/.
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Tell students that you will ask a volunteer to flip a coin.
ƒ First ask students to raise their hands if they think the coin will come up
“heads” (get a count) and then ask the same for “tails.”
ƒ Then ask the volunteer to flip a coin.
Repeat these two steps. Call attention to the outcomes – were they the same or
different in the two tosses?
Explain to students that statisticians (people who work with numbers and issues of
chance and probability) are able to show that over time, the chance of getting heads is
the same as the chance of getting tails. The probability of getting heads can be
written as ½. The same fraction or ratio would be used for tails.
You may also want to note that if a woman is expecting a (single) baby, the
probability of having a boy or a girl is also represented by this fraction – ½.
Point out that we can write the probability of getting heads (or tails) as ½ or as .50 or
50%. When the probability of an event is ½ or 50%, we say there’s a “fifty-fifty”
chance of that event occurring. In this case, we have a fifty-fifty chance of getting
heads (or tails). The probability of getting one side in a toss is the same as the
probability of getting the other.
Explain that students will now have a chance to test whether what statisticians say is
true – that there is a 50% chance of getting either heads or tails.
Divide the class into five groups. Have each group flip a coin 20 times and record
their findings on a sheet. (You want the class to complete a total of 100 coin flips.)
Each group should record their results in the Coin Flipping handout with tally marks
in each column. When they have tossed the coin 20 times, the group should add up
the marks in each column and note the totals at the bottom of the page as indicated on
the handout.
Next, each group should report how many times they got heads and tails. You should
list these totals on the board. Then add up the total for heads and for tails, and
average each for the class. (If you had five groups each flipping a coin 20 times, you
should divide by 100 to get an average). The average for heads and for tails should
each be around 50%. (You may find that students report results such as 48 heads and
52 tails, or 49 heads and 51 tails. If you average these numbers, you should still come
out at about 50.)
Ask if students agree with the statisticians about the 50% chance of getting heads or
tails and why.
Note to Teachers: If your class has access to computers, you may wish to have
students simulate coin flipping by using Ken White’s Coin Flipping site:
http://shazam.econ.ubc.ca/flip/index.html. (Accessed April 2006)
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3. An Even Chance and a Weighted Chance (Large group discussion and
pairwork)
Explain even versus weighted chance with examples by presenting the following
scenario to the class.
Imagine that I want to choose one of you to help me, but I want to be fair and give
you all an equal chance. How might I go about doing this?
(e.g., Put names in a hat and draw one without looking.)
Next, tell the class that you want them to determine the probability that X (name a
student) will be chosen. Use the following scenario:
Let’s say that I ask each of you to print your name on a piece of paper. We then
put each piece of paper in a bag. What is the probability that X will be chosen?
(e.g., If there are 11 people in the class, the probability is one out of eleven or
1/11. If there are 20 people in the class, the probability is one out of twenty or
1/20.)
Move through as many options as are needed. Tell the class that this kind of selection
process is known as a random process because each person has the same chance, or
an even chance, of being chosen.
Next, give the class an example where the chances of being chosen are not even.
Use the following scenario:
Let’s say that I hold the same bag with everyone’s name on a piece of paper. This
time, I tell you that I want a man (or a woman) to help me with the project.
Imagine that my class has 20 people in it and 8 of them are men.
ƒ What are the chances of a man being chosen?
ƒ What are the chances of a woman being chosen?
ƒ Who is more likely to be chosen?
ƒ Why?
The probability of choosing a man is 8/20; of a woman is 12/20. Therefore, it is
more likely that a woman will be chosen because there are more women. Uneven
chances like this are sometimes called weighted chances.
To review, write the following on the board:
Even chance means each person has the same chance.
Weighted chance means not even; some people have a better chance of being
chosen because there are more of them.
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4. Colored Balls Probability Activity
This activity allows students to practice working with probabilities for multiple
outcomes. In this activity, students are told the contents of a brown paper bag that
contains 20 colored marbles or candies (such as M&Ms or Skittles) as follows:
6 blue balls
4 green balls
7 yellow balls
3 red balls
Ask students to work in pairs. Remind students that we determine probability by
dividing the number of ways we can get a particular outcome by the total number of
outcomes possible.
# of ways of getting particular outcome (divided by)
# of possible outcomes
To make this formula clearer, use the balls scenario as an example:
What is the chance of pulling a blue ball out of our bag of 20 balls?(6/20)
Distribute the Colored Balls Worksheet. Ask pairs to complete the worksheet. You
may wish to work on worksheet question 1 (see below) as a class and then leave pairs
to complete the rest of the activity on their own. Circulate to see if students are
carrying out the process correctly and to answer any questions that arise. An answer
key is provided on the next page.
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Colored Balls Worksheet (Answer Key)
1. What is the probability of choosing each color:
(blue 6/20, green 4/20 or 1/5, yellow 7/20, red 3/10)
2. List the colors in order from least likely to be picked to most likely to be picked (or
drawn).
(red, green, blue, yellow)
3. Which color ball do you expect to pick first? Why?
(Answers may vary – some may say yellow because they are the most numerous.)
NOTE: The answers to questions 4, 5, and 6 will vary ONLY IF students DO NOT put the
marble/candy back in the bag, as their worksheet indicates. You may want to point this
out to students. If they, for example, eat the candy, then the number of items in the bag
changes, as does the number of a particular color group.
4. Now, without looking in the bag, take out one ball. What color is it? Is it the color
you predicted? List how many balls of each color remain in the bag, after you take
out this ball.
________
_________
_________
_________
blue
green
yellow
red
How many balls are there in the bag now? [19]
5. Now, what is the probability of choosing each color? [all based on 19 total but with a
change for one of the color groups]
________
_________
_________
_________
blue
green
yellow
red
How did these probabilities change from what you noted in question 1?
6. Given the contents of the bag now, which color do you think you are most likely to
choose next? Which color are you least likely to choose next? Why?
most likely: _____________
least likely: _____________
NOTE: Students pick out a ball 3 times and answer a set of questions like 3-6 each time.
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(Lesson plan continued)
Once students have completed the Colored Ball activity, ask them to share their
experiences. Ask the following questions to prompt discussion:
How well did you predict what color you would pick each time?
Would you make different predictions in the future?
What did you observe about how probabilities change?
Be sure to point out that probabilities change as circumstances change – in this case,
each time students drew a ball, the number of balls in the chosen color changed, and
the total number of balls changed, so the probabilities for each color changed.
Summarize what students have observed so far:
ƒ
ƒ
ƒ
ƒ
ƒ
We have seen that the probability of an event is based on how likely that event is
to occur.
The likelihood of an event depends on how many ways that event can happen and
how many possible outcomes there are.
We have seen how the probability of two outcomes can be the same – or average
out to be the same, as with flipping a coin and getting head or tails. In such a
case, we talk about the chances of events happening as even.
In the Colored Balls activity, we saw that chances can be uneven, or weighted,
like the chances of getting the different colors from each bag.
We have also seen how some probabilities (coin flipping) remain the same,
because nothing changes over time, while other probabilities change because
circumstances change (as with the colored balls).
5. Analyzing health messages with probabilities (Large and small group work)
Tell students that you will now revisit the statements that you saw at the beginning of
the lesson. Show the statements to students again:
The American Cancer Society reports the following:
Among women aged 40 to 59, the risk of developing breast cancer is 1 in 24.
For women up to age 39, the risk is 1 in 207.
Among men aged 40 to 59, the risk of developing prostate cancer is 1 in 39.
For men up to age 39, the risk is 1 in 9,879.
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Ask students to read each of the statements again and then rank the statements in
order from most likely to least likely. Have students write down their answers on a
piece of paper – they may simply list the probabilities as follows:
1 in 24
1 in 39
1 in 207
1 in 9,789
Once students have had a chance to write down their answers, ask for volunteers to
tell which event they thought was most and least likely and why. Accept all answers
at this point. Do not confirm any answers as correct. Some research in health
risk communication has indicated that people with low math skills tend to
automatically associate higher numbers in the denominator with greater risk.
Next, point out to students that information about health risks can be presented in a
number of ways. One way is to use sentences, as they have just seen. Another is to
use pictures to help represent probabilities. Distribute the handout Another Look at
Probabilities to small groups of two or three students. Ask students to look at the
pictures (groups of | and ±) that correspond to each of the health risk statements
noted above. Explain that in each picture (group), the |’s represent people who do
not have the disease, while the ± represents the person that does have the disease.
Give students 5 to 10 minutes to review and discuss the pictures. Then ask students
to review their ranking of the likelihood of the health statements and decide if they
would like to make any changes based on the pictures.
6. Conclusion
Reassemble the whole class and ask students to comment on the following:
How did your ranking of the statements change (if at all) after looking at the
pictures?
(Answers may vary, as some students may have interpreted the statements
similarly in both representations, while others came to a different understanding
through pictures. Some research has suggested that people often misinterpret
these kinds of statements, thinking that larger numbers mean a risk is greater.)
Once students have shared their thoughts on the experience, and if no one has given
the correct order, be sure to convey the correct order from most to least likely:
1 in 24 1 in 39 1 in 207 1 in 9,789
Explain that the larger the second number (or bottom number in a fraction), the less
likely is the one event, since that event represents a smaller proportion of the total
possible outcomes.
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How do you prefer to have information about health risks presented to you – in
sentences with probabilities or pictures, or both? Why?
(Answers will vary.)
Imagine that, at your next physical, your doctor talked to you about your risk of
getting a certain disease and you didn’t understand what that risk meant (if it is a
serious risk for you or not). What questions could you ask your doctor to help
you better understand what your risk of getting the disease is?
(Answers might include: Do I have something like a 1 in million chance or a 1 in
100 chance of getting this disease? Can you draw me a picture to help me
understand my risk of getting this disease?)
Follow-up Activities
A. Representing the Probability of Events: Ask students to think of five different
events – they can be any kind of events (weather, winning the lottery, taking a trip,
achieving a goal, buying something, getting a date with a special person, etc.). Have
students:
a. Give a fraction probability statement to indicate how likely the event is.
b. Develop a graphic representation of how likely the event is (using pictures
like those used in this lesson, showing the event as part of a pie or a cake, or
any other form they choose).
c. Present their work in the next class.
You may wish to work through one student-generated example to be sure that
everyone understands the assignment for homework.
B. Using Probabilities for Decision Making: Have students look at a story strip that
depicts a couple about to decide whether or not to have an amniocentesis. (See the
Materials for Follow-up Activity 2, which include instructions for using the ESOL
Picture Story: Tough Decision, included at the end of this lesson.) Ask students to read
the story and think about what advice they might give the couple, based on the
probability statements provided. Ask students to prepare to explain how they arrived at
their decision in the next class.
C. Exploring Health Risks: Have students explore the concept of health risks through
Web sites designed to offer personal risk assessments. The following website offers links
to assessments of risk for heart disease, diabetes, osteoporosis, cancer, and stroke. This
activity might work well with a whole class in a computer lab.
Visit the Harvard Pilgrim Health Care – Assess My Health Risks Web site at:
http://www.harvardpilgrim.org/portal/page?_pageid=213,38394&_dad=portal&_sche
ma=PORTAL
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Technology Tips
9 SMILE Program Mathematics Index
This site, provided by the Illinois Institute of Technology, is part of the Science and
Mathematics Initiative for Learning Enhancement (SMILE) program that seeks to
“enhance the elementary and high school learning of Science and Mathematics
through the use of the phenomenological approach.” The site has links to a number
of lesson plans that pertain to probability. Each lesson includes hands-on activities
that promote experimentation, observation, and analysis. Visit the SMILE Web site at
http://www.iit.edu/~smile/.
9 Exploring Risk Factors
The on-line GED 2002 Teacher’s Lesson Bank includes a lesson titled Protect Your
Heart, which covers a discussion of risk factors for heart disease and stroke and
provides students with practice in graphing and planning for healthy actions.
Elements of the lesson can be adapted to pre-GED students. The lesson plan and
materials are available at:
http://www.floridatechnet.org/GED/LessonPlans/Science/sciencelesson35.pdf.
HALL/NCSALL Health Literacy Study Circles+
Skills for Disease Prevention and Screening
Lesson 11: (ABE) Introduction to Probability
HALL/NCSALL Health Literacy Study Circles+
Page 12 of 26
Skills for Disease Prevention and Screening
Lesson 11: (ABE) Introduction to Probability (HANDOUTS)
Page 13 of 26
Coin Flipping
Heads
Total
HALL/NCSALL Health Literacy Study Circles+
Screening
Tails
Total
Skills for Disease Prevention and
Lesson 11: (ABE) Introduction to Probability (HANDOUTS)
HALL/NCSALL Health Literacy Study Circles+
Screening
Page 14 of 26
Skills for Disease Prevention and
Lesson 11: (ABE) Introduction to Probability (HANDOUTS)
Page 15 of 26
Colored Balls Worksheet
You have been given a bag of 20
colored balls. The bag contains
6 Blue
4 Green
7 Yellow
3 Red
1. What is the probability of choosing each color?
Blue
_______________________
Green
_______________________
Yellow
_______________________
Red
_______________________
2. List the colors in order from least likely to be drawn to most likely to be drawn.
_______________________
_______________________
_______________________
_______________________
HALL/NCSALL Health Literacy Study Circles+
Screening
Skills for Disease Prevention and
Lesson 11: (ABE) Introduction to Probability (HANDOUTS)
Page 16 of 26
Drawing #1
3. What color do you expect to take out of the bag first? Why?
4. Now, without looking in the bag, take out one ball. What color is it?
Is it the color you predicted?
List how many balls of each color remain in the bag after you take out this ball.
____________ blue
____________ green
____________ yellow
____________ red
Note: Do not put the ball you just took out back into the bag.
How many balls are there in the bag now?
5. Now, what is the probability of choosing each color?
____________ blue
____________ green
____________ yellow
____________ red
How did these probabilities change from what you noted in question 1?
6. Given the contents of the bag now, which color do you think you are most likely
to choose next? Which color are you least likely to choose next? Why?
most likely: _______________
HALL/NCSALL Health Literacy Study Circles+
Screening
least likely: _______________
Skills for Disease Prevention and
Lesson 11: (ABE) Introduction to Probability (HANDOUTS)
Page 17 of 26
Drawing 2
7. Now, without looking in the bag, take out one ball. What color is it? Is it the color
you predicted?
List how many balls of each color remain in the bag after you take out this ball.
_________ blue
_________ green
_________ yellow
_________ red
Note: Do not put the ball you just took out back into the bag.
How many balls are there in the bag now?
8. Now, what is the probability of choosing each color?
_________ blue
_________ green
_________ yellow
_________ red
How did these probabilities change from what you noted in question 1?
9. Given the contents of the bag now, which color do you think you are most likely to
choose next? Which color are you least likely to choose next? Why?
most likely: _______________
HALL/NCSALL Health Literacy Study Circles+
Screening
least likely: _______________
Skills for Disease Prevention and
Lesson 11: (ABE) Introduction to Probability (HANDOUTS)
Page 18 of 26
Drawing #3
10. Again, without looking in the bag, take out one ball. What color is it? Is it the
color you predicted?
List how many balls of each color remain in the bag after you take out this ball.
_________ blue
_________ green
_________ yellow
_________ red
Note: Do not put the ball you just took out back into the bag.
How many balls are there in the bag now?
________________
11. What is the probability of choosing each color now?
_________ blue
_________ green
_________ yellow
_________ red
How did these probabilities change from what you noted in questions 1 and 11?
12. Given the contents of the bag now, which color do you think you are most likely
to choose next? Which color are you least likely to choose next? Why?
most likely: _______________
HALL/NCSALL Health Literacy Study Circles+
Screening
least likely: _______________
Skills for Disease Prevention and
Lesson 11: (ABE) Introduction to Probability (HANDOUTS)
Page 19 of 26
Another Look at Probabilities
Among women aged 40 to 59, the risk of developing breast cancer is 1 in 24.
±|||||||||||
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For women up to age 39, the risk of developing breast cancer is 1 in 207.
±|||||||||||||||||||
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Among men aged 40 to 59, the risk of developing prostate cancer is 1 in 39.
±|||||||||||||||||||
||||||||||| ||||||||
HALL/NCSALL Health Literacy Study Circles+
Screening
Skills for Disease Prevention and
Lesson 11: (ABE) Introduction to Probability (HANDOUTS)
Page 20 of 26
For men up to age 39, the risk of developing prostate cancer is 1 in 9,879
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HALL/NCSALL Health Literacy Study Circles+
Screening
Skills for Disease Prevention and
Lesson 11: (ABE) Introduction to Probability (HANDOUTS)
Page 21 of 26
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HALL/NCSALL Health Literacy Study Circles+
Screening
Skills for Disease Prevention and
Lesson 11: (ABE) Introduction to Probability (HANDOUTS)
Page 22 of 26
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HALL/NCSALL Health Literacy Study Circles+
Screening
Skills for Disease Prevention and
Lesson 11: (ABE) Introduction to Probability
Follow-up Activity
Page 23 of 26
Materials for Follow-up Activity 2: Using Probabilities for Decision Making
Picture Story: Tough Decision
For the teacher:
This exercise is meant to help students think about the tough decisions we face when a
doctor advises us to have a health test or a screening test. We need to think about the
valuable information the test may give us, as well as any risks of having the test. This
picture story is about a couple who have to make a tough decision about getting an
amniocentesis, a test for pregnant women that enables you and your doctor to get
information about the unborn baby. This test is usually done when a woman is about 4
months pregnant. The test can help the doctor learn certain things about the health of the
baby, such as whether a baby has genetic or chromosomal disorders, like Down syndrome.
The test is not regularly given to all pregnant women because there is a risk of miscarriage
and infection. However, women who are going to be 35 or older when their baby is born
are often advised to get the test, as the risk of chromosomal disorders increases with age.
Story Overview: A woman goes to see her doctor and learns that she is pregnant. The
woman is very happy. The woman goes home and tells her husband the good news. They
are very excited. Two months later, the woman goes back to the doctor for a check-up.
The doctor tells her that she should think about amniocentesis because she is 36 years old.
The doctor gives her some information about amniocentesis. The information includes data
about the chances of having a baby with Down Syndrome for women of different ages.
The information also talks about the risk of miscarriage or infection as a result of having
the test. The woman looks worried. The woman goes home to talk to her husband. She
does not know what to do. Her husband does not know what to do either.
Here are some discussion prompts for beginning-level learners who may need help
comprehending the story:
Frame 1: Who are the two women? Where are they? What is the doctor saying to the
woman? What do you think the woman (the patient) is feeling?
Frame 2: Where is the woman now? Who is she talking to? What are the two people
feeling?
Frame 3: When is this happening? What is the doctor saying? What will the doctor do
next? What do you think the woman (patient) is thinking?
Frame 4: What is this information? What does it mean? What makes this information
hard to understand? (Follow-up: Have you ever gotten information like this from a
doctor? Did it make sense? What did you do?)
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Lesson 11: (ABE) Introduction to Probability
Follow-up Activity
Page 24 of 26
Frame 5: What is this next information? What does it mean? What makes this
information hard to understand? (Follow-up: Have you ever gotten information like
this from a doctor? Did it make sense? What did you do?)
Frame 6: Where is the woman now? What are the people talking about? What do
you think they are feeling now? Why?
After discussing Frame 6, emphasize to the students that the information about the risks
and benefits of getting a test can sometimes be very confusing. It’s not always clear
what the “right” thing to do is. This picture story provides the class with an opportunity
to discuss what it means to make an “informed choice,” which can be defined as a
person’s ability to make a choice based on accurate, clear, and useful information and
based on a clear understanding of their health needs. Ask your students to talk about
the meaning of this phrase. Encourage them to use their dictionaries or the Internet for
information about the meaning of the words.
Be sure that students understand the basic plot of the story before they answer the
following discussion questions.
1. What happens in this story? Use your own words and tell the story to
your partner.
2. What is the woman thinking after the doctor tells her she should think about
getting an amniocentesis? What do you think the couple is feeling? Why?
3. If this couple were your friends, what would you tell them?
4. Has this experience ever happened to you? What did you do?
5. What kinds of questions can we ask if our doctor recommends that we have a
health test and we’re not sure what to do?
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Lesson 11: (ABE) Introduction to Probability
Follow-up Activity (HANDOUTS)
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Skills for Disease Prevention and Screening
Lesson 11: (ABE) Introduction to Probability
Follow-up Activity (HANDOUTS)
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Skills for Disease Prevention and Screening
Lesson 12: (GED) Exploring Health Risks as Probabilities
Page 1 of 20
Lesson 12: (GED) Exploring Health Risks as Probabilities
Disease Prevention and
Screening Tasks
Addressed in this Lesson
ƒ Interpret information
on health risks
ƒ Use information on
health risk to inform
decision-making
Skills Focus
ƒ Students will practice
using and interpreting
different mathematical
expressions of
probability.
ƒ Students will practice
using calculators to
convert among
fractions, decimals and
percents.
ABE/ESOL Level
GED
Time
2 to 2-1/2 hours
Materials
handouts
calculators
Vocabulary
chance
event
odds
outcome
risk
Purpose
Information on disease prevention and health risks is
often communicated in mathematical terms, such as
fractions (1/10) or ratios (1 in 200) or as percents (50%
chance). This lesson provides students with a framework
for understanding the likelihood of events, including the
development of diseases or other health conditions.
This lesson teaches students to recognize math
expressions used to express probability. Students also
practice interpreting probability expressions by
converting among fractions, decimals, and percents.
This lesson can be taught on its own or adapted as a
follow-up to the ABE lesson: Introduction to Probability,
included in the Study Circle+ lesson packet.
Prerequisites
This lesson assumes that students have some familiarity
with fractions, decimals and percents. Activities provide
students with opportunities to practice converting among
these forms as expressions of probability.
Steps
1. Introduction (Large group discussion)
Show students the following list of health news
topics with statistics on health risks:
ƒ Over the course of a lifetime, women have a 1 in
8 chance of developing breast cancer. 1
ƒ There is a 25 percent chance that a child born to
parents who both carry a sickle cell anemia gene
will have sickle cell disease. 2
ƒ Exercising three hours per week can lower your
risk of heart disease by 30%. 3
1
Breast Cancer: The Basics. Available at:
http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=33&id=8320
2
Sickle Cell Disease Available at: http://www.marchofdimes.com/professionals/681_1221.asp
3
Exercise and Diet. The Center for Women’s Health, Columbia University. Available at:
http://hora.cpmc.columbia.edu/dept/cwh/exercise.html
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Ask students the following questions:
ƒ Have you seen or heard statements like this before? Where?
ƒ What information do they tell us? What do these numbers mean?
ƒ How useful do you find these statements? Why?
Point out that the idea behind these kinds of statements is something known as
“probability”.
ƒ The word “probability” refers to how likely or unlikely it is for something to
happen.
ƒ We sometimes refer to probabilities as the chance or odds of something
happening.
Explain that we use probabilities to tell us how likely a particular outcome is to occur
for a particular event. Explain the bolded terms below as suggested.
ƒ An event can include things such as getting a gift, having a traffic-free morning
commute, or having a snowstorm in your town.
ƒ An event can also include the following 4 :
a coin toss
rolling a die or rolling two dice
drawing a card from a deck of cards
drawing a marble from a bag of different colored marbles
spinning a spinner on a board game
ƒ An outcome is the result of an event like those just described above.
For instance, a coin toss has two possible outcomes – heads and tails.
Rolling a regular six-sided die has six possible outcomes – 1, 2, 3,4,5 or 6.
Drawing a card from a deck of cards has 52 possible outcomes, since each card is
different.
ƒ The probability of an outcome for a particular event is a number that tells us
how likely a particular outcome is to happen.
Present the following example to students:
How likely is it that I will roll a 3 when I roll a die?
The probability of this outcome is the ratio of the number of ways I can roll a 3 (only
one way) divided by the number of total possible outcomes when I roll a die:
1
6
(only one way to roll a three with only one die)
(the total number of outcomes possible when I roll a die)
4
Adapted from What is an event? Available at:
http://www.mathleague.com/help/percent/percent.htm#whatisanevent
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Note to teacher: If students are feeling confused at this point, let them know that you
will do some activities in this lesson to make the idea of probability clearer.
Explain the concept of health outcomes as suggested below.
ƒ Health outcomes include a broad range of things, including giving birth to a
healthy baby, living to 90, getting cancer, or having a heart attack.
ƒ When medical people talk about the chance or risk of health outcomes, they are
really talking about probabilities of these outcomes occurring. They are referring
to how likely it is, for example, that someone will develop a certain disease.
ƒ When doctors and other health professionals discuss health risks with a patient,
they are using two sets of information.
• Health Statistics. To understand health risks, doctors rely on what
researchers have found out about how many and what types of people get
certain diseases (e.g. men, women, smokers, older people, etc). Health
statistics may also differ based on geography and environmental factors.
• Individual Factors. Next, doctors need to know about each patient. For
example, they must consider a person’s age, current health, tests results,
exposures and behaviors, and family history.
2. Probability Vocabulary Review (Large group discussion and pairwork)
Present a list of some terms associated with probability:
very likely, probable, impossible, highly probable, certain, unlikely, possible, very
unlikely
Ask students to rank these terms according to certainty, from least certain to most
certain. Ask for any other similar terms they may know that could be added to this
list.
Remind students that, as noted above, probability applies to all sorts of events –
everything from winning the lottery to what the weather will be like to the chances of
getting a particular disease.
Using either an overhead or a handout, present students with a list of events like that
below. (Feel free to modify the list to increase its relevance to your students).
It will snow next Christmas Day.
You will watch the news on television tonight.
You will be on time for work tomorrow.
You will see a zebra pulling a cart on the road on your way home tonight.
You will buy a new pair of shoes this month.
The weather will be cold tomorrow.
You will win the lottery.
You will go sky-diving this weekend.
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You will need new glasses in the next year.
Your teacher will speak to you in Thai during this class.
Ask students to take 5 minutes to work with a partner and assign one of the
probability terms noted above to each statement. After 5 minutes, ask volunteers to
share their answers. Point out, as will likely be clear from student responses, that
some events – like buying new shoes or needing glasses -- will be more likely for
some people than for others.
3. Introduce the Probability Scale (Large group discussion and pairwork)
Note that while we can talk about probability with words like very likely or
impossible, very often probability is discussed in terms of numbers.
Point out that all probabilities fall between 0 and 1. A probability of 0 means that an
event is impossible while a probability of 1 means that an event is certain to happen.
Lower probabilities mean that events are less likely, while higher probabilities mean
that events are more likely.
Draw the following scale on the board or an overhead transparency and explain its
use as discussed below.
The Probability Scale
impossible
0
0%
fifty-fifty
.5
50%
certain
1
100%
Point out that the decimals on the probability scale correspond to percentages. So if
an event had a probability of .9, we could say that the probability of that event is
90%, or that there is a 90% chance that that event will happen. When we hear
statements about an event being 90% certain, we know that there is a very good
chance that the event will occur. On the other hand, if something has a 10% chance
of occurring, it is pretty unlikely that that event will happen. The number .5
represents what we often call a “fifty-fifty” chance (a 50% chance) – which means
that it is as likely that an event will occur as it is likely that it will not occur.
In order to help us understand how likely an event is to happen, we can think about
where it would fall on the probability scale. Ask students to revisit the list of events
they looked at earlier in the lesson. Have students again work in pairs to assign a
percentage to each event as a way of expressing the likelihood of that event. You
may wish to focus on one statement as an example:
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Lesson 12: (GED) Exploring Health Risks as Probabilities
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You will be on time for work tomorrow.
Earlier, I said that this event was very likely. Now, I might say that the
probability of that event is 90% – since I’m on time for work almost every day
and I feel very certain I will be again tomorrow.
Ask students to share some answers.
4. Review mathematical expressions of probability (Large group review and
individual practice)
Explain that decimals and percents are two different ways of expressing probabilities.
Probabilities can also be expressed as fractions. Write the following examples on the
board for students to see as you review them.
For example, a probability of
.1 = 10% = 10/100 (1/10) [1 in 10 chance of the event happening]
.5 = 50% = 50/100 (1/2) = [1 in 2 chance]
.25 = 25% = 25/100 (1/4) [1 in 4 chance]
Remind the students that we often refer to these expressions as statistics. Health
messages often contain statistics that we need to understand in order to fully
understand those messages.
Distribute the Expressions of Probability worksheet and ask students to complete
the table like the one below. Invite students to use calculators for this exercise.
Depending on your students’ facility with these calculations, you may wish to review
possible ways to get the equivalent expressions:
If you start with a decimal, turn it into a fraction
e.g. .30 = 30/100 = 30% = 3 in 10 chance [reduce 30/100 to 3/10)
If you start with a fraction, divide the numerator by the denominator to get a
decimal.
e.g, 1/6 = .1667 = 17/100 = 17% = 17 in 100 or 1.7 in 10 chance
If you start with a percentage, turn it into a fraction, then get a decimal
e.g., 75% = 75/100 (or ¾) = .75 = 3 in 4 chance
Review the answers (listed in the table below) as a class and answer any questions
students may have.
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Expressions of Probability – Answer Key
Decimal
Percentage
Fraction
Chance/Odds
.10
10%
10 = 1
100 10
1 in 10
.30
30%
30 = 3
100 10
3 in 10
.75
75%
75 = 3
100 4
3 in 4
.17
17%
1
6
1 in 6
.11
11%
1
9
1 in 9
.05
5%
5 = 1
100
20
1 in 20
.001
.1%
_ 1___
1,000
1 in 1,000
.88
88%
7
8
7 in 8
.90
90%
90 = 9
100
10
9 in 10
.02
2%
2 = 1
100 50
1 in 50
5. Assessing the likelihood of events (Four corners and pair work)
In this activity, you will ask students to consider four causes of death (car accident,
plane crash, being hit by a car, being struck by lightning). Students will choose
which cause they think poses the greatest risk to the average person in the U.S. and
then position themselves in an area of the room associated with that cause. Students
then think about their choices and discuss how their perceptions of risk are developed.
Finally, students brainstorm questions they can ask their doctors to help clarify health
risk messages.
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List the following four potential causes of death on the board or overhead.
Car accident
Plane crash
Being hit by a car or other vehicle
Being struck by lightning
Ask students to think silently about which cause of death they think is most likely;
that is, which cause poses the greatest risk to the average person in the U.S. over the
course of a lifetime. Assign each cause of death to one corner of the room. Place a
piece of newsprint in each corner with the name of the cause of death on it. Give
students 2 minutes to move to the corner that corresponds to the cause of death that
they think is most likely (not necessarily to them – but generally speaking).
Once students have arrived at their chosen location, ask volunteers to explain their
choices to the whole class. Ask students to note what factors influenced their choice
of the most likely event.
Next, ask students to split into pairs and give each pair a set of 4 post-it notes with the
following statistics on them (1 statistic per note):
1 in 83, 930
1 in 4,023
1 in 247
1 in 608
On the newsprint in each corner, ask students to post the statistic that they think
corresponds to the probability of each cause of death/event. Once students have done
this, you can reveal the correct matching statistic for each cause of death. Ask
students to comment on what they notice about their predictions and the actual
probabilities.
lifetime odds
car
1 in 247
air
1 in 4,023
pedestrian
1 in 608
lightning
1 in 83, 930
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Note: These statistics are from the National Safety Council (NSC). 5 They are based on
data from the National Center for Health Statistics and U.S. Census Bureau.
6. Review student perceptions of risk (Large group discussion)
Pose the following questions to the class for discussion.
How did your perceptions of risk (your ideas before seeing the statistics) differ
from the statistics?
(e.g., I thought it was riskier to be a pedestrian than to be in a car.)
What kinds of things influence how you view the risk of events such as these?
Answers may include: 6
Personal experience
Cultural attitudes and beliefs
What we see in newspapers, magazines, and on TV
Not understanding science well
Whether something is familiar (diabetes) or exotic (West Nile virus)
Whether something is common (flu) or dreaded (cancer)
Whether something is a natural risk (lightning) or man-made (chemical
contaminants)
What kinds of things might influence how you feel about health risks?
Answers may be similar to those above, and may include comfort with habits,
such as smoking, eating, exercise, etc.
Point out that researchers who have looked at our understanding of risk have noted
that our perception of risk is influenced by whether a hazard is present (e.g., whether
there are reports of West Nile virus in our state or city), how much we are exposed to
the hazard (e.g., how often we actually fly on an airplane), how much we feel
threatened by the hazard, plus how much control we feel we have over whether or not
the event occurs 7 .
5
The NSC website explains lifetime odds as follows: one year odds are approximated by dividing the
2001 population (285,093,813) by the number of deaths. Lifetime odds are approximated by dividing the
one-years odds by the life expectancy of a person born in 2001 (77.2 years).
http://www.nsc.org/lrs/statinfo/odds.htm
6
Adapted from Communicating About Risk: Implications for Public Health and Clinical Practice by
James Hyde, Associate Professor, Tufts School of Medicine Presented at The American College of
Preventive Medicine, San Antonio, Texas February 20, 2002
http://www.hsph.harvard.edu/healthliteracy/slides/hyde_01.html
7
Adapted from Communicating About Risk: Implications for Public Health and Clinical Practice by
James Hyde, Associate Professor, Tufts School of Medicine Presented at The American College of
Preventive Medicine, San Antonio, Texas February 20, 2002
http://www.hsph.harvard.edu/healthliteracy/slides/hyde_01.html
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7. Conclusion: Improving communication with doctors about health risks (Small
group discussion)
Point out that, so far in this lesson, students have explored the concept of probability
and ways that probability can be expressed – as words (likely, very likely, etc.) and
numbers (fractions, percents, decimals and odds).
To conclude the lesson, you will ask students to think about how they can improve
their understanding of risk when they meet with health professionals.
Distribute the Talking About Risk in Health Care Settings handout. Ask students
to work in groups of 3 to focus on one of the 5 scenarios listed on the handout. You
may wish to assign scenarios to groups to be sure that all 5 scenarios are discussed.
Ask students to think about what questions they could ask the doctor in response to
the health risk message the doctor tells each patient.
Give students around 10-15 minutes to discuss the problems and prepare to share
their ideas with the class. When groups are ready, ask a representative from each
group to share ideas and record them on the board.
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Talking About Risk in Health Care Settings
(Teacher Version)
1. Mario’s father died of prostate cancer, so his doctor has told Mario that he is “at
risk” of getting the disease too. What questions could Mario ask to more clearly
understand his risk of getting the disease?
(e.g., How likely is it that I will get cancer? Can you use numbers or show me on a
scale? What can I do to reduce my risk? )
Do you think Mario should be concerned about his risk of prostate cancer? Why?
(Answers will vary – Just because he’s at risk doesn’t mean he will get it. There may
be things he can do to lower his risk.)
2. Joyce goes to the doctor for a check-up. During the visit, her doctor tells Joyce that
given her age, current health and family history, she has a 1 in 200 chance of
developing a certain type of cancer. Joyce has never heard this kind of information
before and is confused by the numbers. What could she ask the doctor to do to make
his message clearer?
(e.g., What does 1 in 200 mean – is that very likely, not very likely, almost certain?
Can you show me a picture? What can I do to reduce my risk?)
Do you think Joyce is at great risk of developing cancer? Why?
(Answers may vary: 1 in 200 doesn’t seem like a great risk to me. Or, 1 in 200
sounds risky to me.)
3. Simon has a problem with his heart and needs surgery. The doctor said that there’s a
30% chance that the operation will not work. What questions could Simon ask to
learn more about the risks involved in his surgery?
(e.g., What does 30% mean? What is the chance that the surgery will work? What if I
don’t do the surgery? (This last question is not pertinent to interpretation of
probability but relevant to the conversation overall.)
Does Simon’s surgery sound very risky to you? What would you advise him to do?
(Answers will vary. Some people may feel that a 70% chance of success is enough,
while others may not.)
4. Elena has arthritis. Her doctor gave her a new medicine and said that there’s a 60%
chance that the medicine will help her. What questions can Elena ask to understand
what this means.
(e.g., So, there’s still a 40% chance it won’t work? What are the side effects? What
will happen to me if I don’t take this medicine? Are there others I can take?)
Do you think it’s a good idea for Elena to take the medicine? Why?
(Answers will vary. Some people may feel that 60% is not good enough, especially if
there are side effects of the medicine.)
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In bringing the discussion to a close, you will want to highlight the following:
ƒ
It is especially important to ask questions in a doctor visit when you are
discussing the risk of getting a disease, or the risks of a certain treatment or
procedure.
ƒ
What doctors tell us about risk – the probability, or statements like being “at risk”
- will mean different things to different people. For some, a 70% chance of
success is good enough, while for others it may not be. Get information from
your doctor, ask questions so you understand your situation, and then do what’s
comfortable for you.
Conclude the lesson by directing students to an appropriate follow-up activity.
Note to teacher: Following this lesson, you may wish to prepare a summary handout
based on this discussion for students to have for future reference when visiting a
doctor. You may wish to include the following points 8 :
ƒ
Ask for the risk message in a different form. For example, if the doctor uses a 1 in
X statement, ask to hear that as a percent.
ƒ
Ask for a picture to represent risk – a shaded pie chart, for example.
ƒ
If the doctor explains the risk of a problem occurring, ask what the risk of things
being O.K. is – eg, if there’s a 40% chance that a drug won’t work, then what is
the likelihood that it will work?
ƒ
If the doctor talks about a change in risk – e.g., 30% decrease or 40% increase –
ask what the risk is before the increase or decrease.
ƒ
Ask the doctor to show the risk on a probability scale like the one used in class.
ƒ
Ask the doctor to repeat, speak more slowly, or use simpler words.
ƒ
Tell the doctor what you have understood and ask if this is correct.
8
List adapted from “Strategies to help patients understand risks” by John Paling. BMJ volume 327,
September 2003. Available at www.bmj.com
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Follow up activities
A. Probability and Health Risk Review Activity. Have students complete the
Probability and Health Risk Review Activity, which follows this lesson plan, and
return it to you as a check on their understanding of the material covered in the
lesson.
B. Probability in the News. Ask students to look through newspapers and magazines
to find expressions of probability and present them to the class – explaining what the
issue is, how the probability is presented, alternatives for presenting it (e.g., percent,
fraction, picture) and how the student views the risk involved – high, low, etc.
E.g.,: A recent quote from Newsweek: ‘If you smoke a pack a day for 20 years or
more, you have a 50 percent chance of dying from smoke-related disease.’ 9
C. Research on Risk. Have students research the risks associated with a topic of
their own interest such as a particular disease (e.g., diabetes) or an activity (e.g.,
smoking, sky diving).
Technology Tips
9 Presenting Risk with Visual Aids
This website offers a useful introduction to the concept of risk via a moving visual
presentation of risk. If you have a computer lab available to you and your
students, this site might serve as an alternative introduction to this lesson.
https://www.besttreatments.org/risk
9 Risk Charts
Particularly for GED students, you may wish to explore the website described
below, which has links to a series of charts that show the risk of death due to
cancer. The charts can provide practice in table reading skills as well as
information for further discussion of risk.
Risk Charts: Putting Cancer in Context
Risk charts are simple, low-tech, visual tools that put disease risk into context.
Schwartz and her colleagues have created examples of risk charts that show how
many people out of 1000 will die of a particular disease within the next 10 years.
There are separate charts for men and women, smokers and non-smokers, with
risk data for people ages 20 to 90. The charts not only are appealing to look at, but
also easy to understand. You can find examples and more information about risk
charts at the Journal of the National Cancer Institute's Web site:
http://www.jncicancerspectrum.oupjournals.org/cgi/content/full/jnci;94/11/799?ij.
9
Statement by Dr. Norman Edelman, American Lung Association’s chief medical officer. In “The
Deadliest Cancer.” Newsweek, August, 22, 2005, p. 44.
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9 Risk Statistics
This British website offers relevant statistical resources to support lessons or
lectures –statistics of comparative risks and a variety of charts that present risk in
different formats (tables, bar charts, etc.).
http://www.hse.gov.uk/education/statistics.htm#death
9 Manage My Health: Assess My Health Risks
This website from Harvard Pilgrim Health Care provides links to a series of sites
that allow a person to assess their health risk in multiple areas, including cardiac
health, diabetes, cancer, stroke, osteoporosis, and more.
http://www.harvardpilgrim.org/portal/page?_pageid=213,38394&_dad=portal&_s
chema=PORTAL
9 Making sense of risk information on the Web
Although the language used in this website may be a bit complex for your
students, this website may serve as a useful resource for you as you guide your
students in exploring and interpreting risk information on the web. The author
suggests some useful pieces of information/questions to consider when reviewing
risk information.
http://bmj.bmjjournals.com/cgi/content/full/327/7417/695
9 Exploring Risk Factors
The on-line GED 2002 Teacher’s Lesson Bank includes a lesson titled Protect
Your Heart (Lesson 35), which covers a discussion of risk factors for heart
disease and stroke, and provides students with practice in graphing and planning
for healthy actions. Elements of the lesson can be adapted to pre-GED students.
The lesson plan and materials are available at:
http://www.floridatechnet.org/ged/LessonPlans/Science/Science.htm
ESOL Tips
Students may benefit from practice in using the language of risk. You may want
to ask them to role-play scenarios such as those included in the Talking About
Risk in Health Care Setting activity. You may also want to include some
discussion of how risk is perceived and discussed in other cultures. For example,
do people openly discuss risks, especially those pertaining to health? Do doctors
discuss risk in terms of numbers or in other ways?
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Lesson 12: (GED) Exploring Health Risks as Probabilities
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Skills for Disease Prevention and Screening
Lesson 12: (GED) Exploring Health Risks as Probabilities (HANDOUTS)
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Expressions of Probability
Complete the table below by filling in the missing values. Follow the
example provided.
Decimal
Percentage
Fraction
Chance/Odds
.10
10%
10 = 1
100 10
1 in 10
.30
75%
1
6
1 in 9
.05
.1%
7
8
9 in 10
2%
HALL/NCSALL Health Literacy Study Circles+
Skills for Disease Prevention and Screening
Lesson 12: (GED) Exploring Health Risks as Probabilities (HANDOUTS)
HALL/NCSALL Health Literacy Study Circles+
Page 16 of 20
Skills for Disease Prevention and Screening
Lesson 12: (GED) Exploring Health Risks as Probabilities (HANDOUTS)
Page 17 of 20
Talking About Risk in Healthcare Settings
1. Mario’s father died of prostate cancer, so his
doctor has told Mario that he is “at risk” of
getting the disease too. What questions could
Mario ask to more clearly understand his risk
of getting the disease? Do you think Mario
should be concerned about his risk of prostate
cancer? Why?
2. Joyce goes to the doctor for a check-up.
During the visit, her doctor tells Joyce that
given her age, current health, and family
history, she has a 1 in 200 chance of
developing a certain type of cancer. Joyce has
never heard this kind of information before
and is confused by the numbers. What could
she ask the doctor to do to make his message
clearer? Do you think Joyce is at great risk of
developing cancer? Why?
3. Simon has a problem with his heart and needs
surgery. The doctor said that there’s a 30%
chance that the operation will not work. What
questions could Simon ask to learn more
about the risks involved in his surgery? Does
Simon’s surgery sound very risky to you?
What would you advise him to do?
4. Elena has arthritis. Her doctor gave her a new
medicine and said that there’s a 60% chance
that the medicine will help her. What
questions can Elena ask to understand what
this means? Do you think it’s a good idea for
Elena to take the medicine? Why?
HALL/NCSALL Health Literacy Study Circles+
Skills for Disease Prevention and Screening
Lesson 12: (GED) Exploring Health Risks as Probabilities (HANDOUTS)
HALL/NCSALL Health Literacy Study Circles+
Page 18 of 20
Skills for Disease Prevention and Screening
Lesson 12: (GED) Exploring Health Risks as Probabilities (HANDOUTS)
Page 19 of 20
Probability and Health Risk Review Activity
At her annual physical, Mrs. Sanchez's doctor tells her that her risk of developing
a certain disease is about 1 in 50.
1. Mrs. Sanchez does not understand what this statistic (1 in 50) means. What
are two questions that she might ask her doctor to help her better
understand her situation/risk of getting this disease?
2. What is the probability of her getting the disease, expressed as a decimal
and a percent?
3. Do you think Mrs. Sanchez is at a “high risk” for this disease? Why?
4. Once Mrs. Sanchez understands what 1 in 50 means, what other questions
might she ask her doctor?
HALL/NCSALL Health Literacy Study Circles+
Skills for Disease Prevention and Screening
Lesson 12: (GED) Exploring Health Risks as Probabilities (HANDOUTS)
HALL/NCSALL Health Literacy Study Circles+
Page 20 of 20
Skills for Disease Prevention and Screening